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studies  upon  the  Cerebral  Cortex  in  the 

Normal  Human  Brain  and  in 

Dementia  Paralytica 

By  0.  ALFREO  LAWRENCE    . 


BP^^^Sllbmitted  in  partial  fulfilment  of  the  requirements  for  the  degree  of 
t:  Doctor  of  Philoscfphy  in  the  Faculty  of  Pure  Science,  Columbia  Univer- 
f-      sity. 


Reprinted  from  the  JOURNAL  OF  NERVOUS  AND  MENTAL  DISEASES* 
VoL  XXX,  Nos.  9,  to.  U  and  12 


COLUMBIA  UNn"^PS'TY 

DEPARTMENT  OF  PHYSiPLOny 

College  of  Physicians  and  Surgeons 

437  WEST  FIFTY  NINTH  STREET 
NEW  YORK 


ALLIANCE   PRESS    COMPANY 
NEW   YORK   CITY 
J903 


STUDIES  UPON   THE  CEREBRAL   CORTEX   IN   THE   NORMAL 
HUMAN   BRAIN  AND   IN   DEMENTIA   PARALYTICA.' 

By  G.  Alfred  Lawrence,  M.D.,  Ph.D.,  of  New  York. 

instructor  in  diseases  of  the  mind  and  nervous  system^  new  "vork 
post-graduate  medical  school  and  hospital 

Introductory.     The  following  contribution  to  the  study  of  the 
cerebral  cortex  in  the  normal  human  brain  as  compared  to  that 
in  dementia  paralytica,  does  not  include  much  that  is  new  to  the 
pathology  of  the  latter,  but  aims  to  present  the  subject  in  a  some- 
what  different   manner   than   has   heretofore   been    done.      The 
writer's  perusal  of  many  anatomical  and  pathological  articles  has 
often  been  unsatisfactory  to  himself,  owing  to  many  generalized 
statements  of  conditions  found  without  any  adequate  illustrations 
of  what  was  really  to  be  seen.     It  has  been  the  endeavor  in  this 
!-ticle  to  present  and  describe  photomicrographs  of  actual  sec- 
jns  from  a  practically  norrnal  human  brain  histologically  by  way 
•  f  comparisori,  and  to  follow  these  by  photomicrographs  of  sec- 
ons  of  a  brain  of  a  well  marked  case  of  dementia  paralytica. 
These  photomicrographs  have  been  supplemented  by  drawings. 
The  possibilities  as  well  as  the  limitations  of  photomicrography  in 
preparations  stained  by  the  Nissl  method,  it  seems  to  the  writer, 
ire  fairly  well  brought  out  in  this  article,  and  this  was  one  of  the 
Dbjects  sought  in  its  presentation.     That  photomicrographs  show 
structure  and  arrangement  in  but  one  plane  of  limited  thickness 
is  true.    It  is  also  true,  however,  that  they  show  exactly  what  is 
there  and  the  exact  relation  to  other  parts,  and  there  is  no  personal 
equation  such  as  is  bound  to  occur  in  any  drawing.     A  drawing, 
on  the  other  hand,  is  always  more  or  less  composite,  does  not 
show  exact  relationship,  and  involuntarily  the  point  to  be  illus- 
trated is  made  to  assume  undue  prominence.     In  work  of  this  kind 
artefacts  are  constantly  to  be  looked  for  and  avoided,  and  the 
entire  process  of  preparation,  as  well  as  the  history  of  the  case, 
must  be  also  carefully  considered  before  any  conclusions  should 
be  drawn. 

'Submitted  in  partial  fulfilment  of  the  requirements  for  the  degree  of 
Doctor  of  Philosophy  in  the  Faculty  of  Pure  Science,  Columbia  University. 


2,  G.  ALFRED  LAWRENCE. 

When  it  is  considered  how  extremely  thin  the  human  cortex  is, 
^•5  to  3.5  milHmeters ;  that  its  exterior  surface  is  estimated  at 
about  200,000  square  millimeters ;  that  it  is  intricately  arranged  in 
convolutions  of  varying  size  and  direction ;  that  it  is  exposed  to 
injury  prior  to  death,  at  the  autopsy,  during  transportation,  and 
also  in  the  various  manipulations  of  fixation,  imbedding,  section- 
ing, staining,  decolorizing  and  mounting,  it  can  readily  be  seen 
how  artefacts  may  result  by  the  time  the  specimen  is  prepared  for 
examination.  This  was  forcibly  brought  to  the  notice  of  the 
writer  in  the  examination  of  some  sections  but  a  short  time  ago. 
Owing  to  a  dull  microtome  knife  the  nuclei  of  a  number  of  the 
cells  were  completely  carried  outside  of  the  cell-body  and  the  cell- 
bodies  themselves  broken  and  cracked  in  places.  This  was  at  first 
regarded  as  a  pathological  process  until  attention  was  called  to 
the  fact  of  the  nuclei  all  being  extruded  in  the  same  direction, 
and  the  breaks  and  cracks  presenting  a  ragged  and  irregular  ap- 
pearance. Even  when  the  greatest  care  is  used  there  will  be  a 
variation  in  thickness  in  different  sections — one  being  somewhat 
thinner  and  the  next  correspondingly  thicker  than  actually  regis- 
tered by  the  microtome,  although  most  carefully  imbedded,  so  that 
variations  in  the  thickness  are  also  to  be  considered.  Further- 
more, in  fixation,  shrinkage  or  swelling  may  occur,  the  latter 
being  demonstrated  by  Donaldson  ( 1891 ) ,  who  placed  fresh  nerves 
in  a  solution  made  up  of  2.5  per  cent  of  potassium  bichromate, 
plus  one-sixth  its  volume  of  95  per  cent  alcohol  for  three  weeks. 
He  then  washed  them  for  one  day  in  water  and  placed  them  in  95 
per  cent,  alcohol  for  three  or  four  days,  and  finally  in  80  per  cent 
alcohol,  using  six  olfactory  bulbs,  six  olfactory  tracts,  and  three 
pairs  of  optic  nerves  of  the  sheep.  This  was  exactly  the  same 
treatment  to  which  his  specimens  of  human  nerves  had  been  sub- 
jected. The  volume  of  specimens  of  olfactory  bulbs  subjected  to 
this  treatment  and  afterwards  placed  in  80  per  cent  alcohol  was 
found  to  be  5.2  per  cent  greater  than  fresh  specimens,  those  of  the 
olfactory  tracts  8.8  per  cent  greater,  while  the  optic  nerves  showed 
but  2.6  per  cent  increase  in  volume.  Imbedding  in  celloidin  did  not 
affect  the  volume,  while  some  stains,  as  acid  fuchsin,  produced  no 
change,  whereas  Delafield's  hematoxylin  caused  swelling,  and  thus 


DEMENTIA  PARALYTICA.  3 

increase  in  volume.  Hammarburg  (195)  found  by  experimenting 
with  small  blocks  of  cortical  tissue  that  by  accurate  measurements 
blocks  hardened  in  Miiller's  fluid  for  three  days  showed  a  volu- 
metric increase  of  11.7  per  cent.  Other  blocks  hardened  in  Mill- 
ler's  fluid  for  three  weeks,  and  then,  transferred  to  alcohol  and 
left  in  the  latter  for  fourteen  days,  showed,  on  the  other  hand,  a 
shrinkage  in  volume  of  43  per  cent.  In  alcohol,  95  per  cent,  at 
the  end  of  twenty-four  hours,  a  shrinkage  in  volume  of  20.5  per 
Cent  was  observed.  This  shrinkage  is  furthermore  found  to  vary 
with  different  blocks  from  the  same  region  of  the  same  brain,  and 
it  is  found  that  there  is  no  constant  relation  between  pieces  from 
brains  of  various  grades  of  hardening.  Thus  thef  method  of  fixa- 
tion must  always  be  taken  into  consideration.  Again,  in  staining 
under  exactly  similar  conditions,  one  section  on  a  slide  will  be 
found  more  intensely  stained  than  another  section  on  the  same 
slide,  or  even  one  part  of  a  section  will  be  found  more  intensely 
stained  than  some  other  part  of  the  same  section. 

In  the  subsequent  decolorization  still  greater  variations  may 
occur,  for,  if  carried  too  far,  important  structures  may  be  com- 
pletely decolorized.  If  carried  to  the  other  extreme  it  is  impos- 
sible to  differentiate  the  various  parts.  The  only  way  to  avoid 
either  extreme  is  by  repeated  examination  of  the  sections  under 
the  microscope  while  the  process  is  being  carried  on,  as  under 
similar  circumstances  one  section  in  a  given  time  may  become 
much  more  decolorized  than  another.  In  regard  to  mounting  of 
sections  stained  by  the  Nissl  method,  as  all  were  that  have  been 
employed  in  this  article,  xylol-damar  has  given  the  greatest  satis- 
faction to  the  writer.  With  this  mounting  medium  there  was  no 
subsequent  shrinkage,  and  thus  a  resulting  exposure  of  the  sec- 
tions, also  no  decolorization  was  to  be  observed  at  later  periods. 
In  some  sections  mounted  for  over  three  years,  no  decororization 
was  observed,  even  after  several  exposures  to  the  intense  light 
necessary  for  photomicrographic  purposes,  and  frequent  expo- 
sures to  light  in  their  examination  under  the  microscope,  Canada 
balsam  was  also  used,  but  in  time  the  sections  were  found  par- 
tially  or   completely   decolorized.     Benzene-colophonium    has   a 


4  G.  ALFRED  LAWRENCE. 

tendency  to  shrink  and  crack  and  thus  expose  portions  of  the  sec- 
tions in  some  cases. 

It  is  desired  to  emphasize  the  importance  of  careful  attention 
to  all  these  details  at  the  beginning  of  the  article,  in  order  to 
impress  upon  the  reader  the  necessity  of  the  greatest  care  and 
conservatism  in  the  interpretation  of  any  changes  found  in  the 
specimens  under  observation,  and,  furthermore,  the  correct  in- 
terpretation of  the  same.  Before  going  on  to  the  main  subject  of 
the  article,  a  brief  historical  review  of  work  in  this  line  will  be 
given. 

Historical.  The  first  study  of  the  internal  structure  of  the 
nerve  cells  began  over  fifty  years  ago  when  Remak  (1841)  called 
attention  to  a  fibrillary  structure  inside  the  axis  cylinder  and  cell- 
body  of  certain  nerve  cells.  Later,  Max  Schultz  (1872)  studied 
nerve  fibers  and  cells  from  various  parts  of  the  central  nervous 
system  of  different  animals  with  elaborate  descriptions  of  his  find- 
ings. He  dealt  with  a  description  of  the  fibrillary  appearance  of 
the  interior  of  the  cell-body  largely.  This  doctrine  of  the  nerve 
cell  was  afterwards  strongly  supported  by  Boll  (1873),  Schwalbe 
(1885),  and  Ranvier  (1878).  Opposite  views  were,  however, 
held  by  Arndt  (1874),  and  Key  and  Retzius  (1876).  Arndt,  in 
1874,  described  the  structure  of  the  spinal  ganglion  cells  and 
spoke  of  the  presence  in  them  of  different  kinds  of  elementary 
spherules  which  varied  in  size  and  general  appearance.  Key  and 
Retzius  stated  that  the  ground  substance  of  the  spinal  ganglion 
cells  was  homogeneous,  but  that  in  it  numerous  strongly  refrac- 
tive, round,  oval  granules  were  present,  and  they  thought  the  ap- 
pearance of  a  concentric  striation  or  fibrillation  could  be  simu- 
lated through  the  arrangement  of  the  granules  in  rows.  Flem- 
ming  (1-882)  saw  granules  within  the  cells  which  would  stain 
with  nuclear  and  azo  dyes  and  hematoxylin,  but  nevertheless 
affirmed  a  fibrillary  structure  of  the  central  cells  and  of  a  tortuous 
or  much  curved  threadwork  within  the  spinal  ganglion  cells  be- 
tween the  granules.  In  recently  published  articles  (1896)  he  still 
maintains  that  fibrils  exist  inside  the  nerve  cell  protoplasm. 

Dogiel  (1893)  has  also  expressed  himself  in  favor  of  the 
views  of  a  fibrillary  structure  for  certain  at  least  of  the  nerve 


DEMENTIA  PARALYTICA.  5 

cells.  In  1885  Nissl  published  the  first  of  a  series  of  articles 
in  which  he  calls  particular  attention,  in  tissues  hardened 
in  alcohol  and  stained  in  basic  aniline  such  as  majenta  red  and 
methylene  blue,  to  certain  structures.  By  Nissl's  method  these 
are  brought  especially  well  into  view,  and  their  arrangement  in 
the  protoplasm  and  their  significance  for  the  function  of  the  cell 
can  be  studied. 

These  structures  had  been  previously  observed  by  Flemming 
and  Benda  (1882),  but  by  less  perfect  methods.  Nissl  at  first 
stained  tissues  hardened  in  alcohol  with  magenta  red  or  meth- 
ylene blue,  and  cleared  in  oil  of  origanum.  This  has  been  modi- 
fied in  several  ways,  so  that  at  present  his  treatment  is  as  follows : 
Small  blocks  of  tissue  are  hardened  in  96  per  cent  alcohol  and 
fastened  by  Weigert's  method  with  gum  arable,  without  imbed- 
ding. The  sections  are  received  in  96  per  cent  alcohol  and  stained 
in  a  watch  glass.  The  stain  is  to  be  heated  over  the  spirit  flame 
until  small  bubbles  arise  which  make  a  crackling,  noise  (65°  to 
70°  C.)  ;  sections  are  then  transferred  to  aniline-oil-alcohol  until 
differentiated.  The  process  of  differentiation  is  ended  when  no 
more  coarse  clouds  of  color  go  off  into  the  fluid.  The  section  is 
then  transferred  to  the  slide,  dried  with  filter  paper,  after  which 
some  drops  of  oil  of  cajeput  are  applied,  and  the  sections  are 
again  blotted  with  filter  paper.  A  few  drops  of  benzene  are 
poured  on  the  sections,  blotted  again,  and  finally  some  benzene- 
colophonium  added,  a  cover  glass  placed  over  the  section,  and  the 
slide  heated  until  all  the  benzene  gas  has  been  driven  off.  Upon 
cooling,  the  section  is  thus  permanently  mounted. 

The  stain  is  made  as  follows :  Methylene  blue,  B.  pat.,  3.75 
grams;  Venetian  soap,  1.75  grams;  distilled  water  or  soft  water, 
1,000  c.  c.  The  differentiating  or  decolorizing  fluid  has  the  fol- 
lowing composition:  Aniline  oil,  colorless,  10  parts;  alcohol,.  96 
per  cent,  ninety  parts.  Nissl  obtains  his  aniline  oil  directly  from 
the  factory  at  Hochst  and  keeps  it  carefully  protected  from  the 
light.  The  benzene-colophonium  is  prepared  by  pouring  benzene 
upon  colophonium  (white  rosin)  and  alowing  it  to  stand  for  from 
twenty-four  to  thirty  hours.  This  results  in  a  fluid  transparent 
mass  which  can  be  brought  to  the  desired  thickness  either  by  the 


6  G.  ALFRED  LAWRENCE. 

addition  of  more  benzene  or  by  allowing  it  to  evaporate,  and  then 
it  is  ready  for  use.  In  mounting,  while  driving  off  the  benzene 
gas  by  heating  over  the  flame,  the  material  may  catch  fire,  but  if 
the  flames  are  blown  out  immediately  no  injury  is  done,  and  the 
alterations  produced  by  the  burning  are  quite  characteristic  and 
easily  recognizable.  The  above  description  has  been  given  in 
detail  as  it  is  the  classical  method,  which,  as  above  and  with 
various  modifications  to  be  described  later,  has  been  used  by  the 
writer  in  this  article.  This  method  distinguishes  within  the  cell- 
body  always  two  and  sometimes  three  constituents.  One  of  these 
constituents  of  the  protoplasm  stains  entirely  blue  by  this  method, 
and  is  spoken  of  by  Nissl  as  the  stainable  or  visible  formed  part 
of  the  nerve  cell.  The  second  part  remains  entirely  unstained,  and 
is  spoken  of  by  him  as  the  unstainable  or  the  visible  unformed  part 
of  the  nerve  cell-body.  In  addition  to  the  above,  in  many  nerve 
cells,  pigmentary  deposits  are  visible  which  have  been  especially 
studied  recently  by  Rosin  ( 1896) .  Nissl  has  prepared  a  somewhat 
elaborate  classification  of  cells  according  to  the  character  and  ar- 
rangement of  the  stainable  portion  to  the  non-stainable  portion 
of  the  cell-body  in  different  cells  in  different  parts  of  the  central 
nervous  system.  This  stainable  substance  shows  a  series  of  dif- 
ferent forms ;  smaller  and  larger  granules  of  regular  or  irregular 
shape,  arranged  in  groups  or  rows,  These  stainable  masses  are 
sometimes  arranged  in  threads,  smooth  or  rough,  and  varying  in 
thickness,  course,  and  length.  Often  larger  structures,  regularly 
or  irregularly  shaped,  are  seen,  which  stain  with  varying  degrees 
of  intensity,  some  appearing  homogeneous,  others  showing  a 
complex  internal  construction  difficult  to  describe. 

Three  varieties  of  these  larger  bodies  are  especially  to  be 
noted,  (i)  the  so-called  ''nuclear  caps"  (Kernkappen),  stainable 
masses  in  the  form  of  regular  or  irregular  cones  hollowed  out  like 
a  cap  and  corresponding  to  one  pole  of  the  nucleus  upon  which  it 
rests.  There  may  be  two  such  caps  within  one  cell-body  at 
opposite  poles,  and  occasionally,  according  to  Nissl,  three  such 
caps  may  exist  within  a  single  cell.  (2)  So-called  "wedges  of 
division"  (Verzweigungs-Kegeln),  stainable  masses  completely 
filling  the  angle  at  the  point  of  division  of  a  nerve  cell  process. 


DEMENTIA  PARALYTICA.  7 

(3)  Spindles,  oblong  spindle-shaped  stainable  bodies,  thick  in  the 
middle  and  thinner  at  both  ends,  the  latter  sometimes  tapering 
off  into  rhread-like  filaments.  These  spindles  may  be  one  or  two- 
sided.  Any  one  of  these  forms  may  be  vacuolated.  Nissl  makes 
a  rather  elaborate  classification  of  these  ganglion  cells  according 
to  their  internal  morphology,  after  spending  years  in  the  most 
exact  investigations  of  various  nerve  cells  in  the  different  nerve 
centers  of  man  and  animals.  He  has  come  to  the  conclusion  that 
definite  types  or  variations  of  nerve  cells  exist  which  are  constant 
not  only  in  the  same  animal  but  often  exist  characteristically  in 
homologous  localities  in  a  whole  series  of  animals.  According  to 
him,  all  the  cells  in  the  nerve  centers,  except  the  so-called  chromo- 
phile  nerve  cells,  can  be  divided  into  two  main  classes.  The  first 
class  includes  the  nerve  cells  which  possess  a  well  marked  cell- 
body  surrounding  the  nucleus  completely  on  all  sides,  the  proto- 
plasm having  a  distinct  contour.  These  are  called  somatochrome 
nerve  cells.  The  second  class  (sub-divided  into  two  groups,  cyto- 
chrome and  caryochrome)  includes  those  cells  in  which,  in  Nissl 
preparations,  the  nucleus  is  most  in  evidence,  the  nucleus  has  a 
clear  contour,  but  only  indications  of  a  cell-body  are  present,  an 
appearance  due  to  either  the  scanty  development  of  the  cell-body 
or  to  the  predominance  in  it  of  the  unstainable  substance. 

These  cells  often  look  as  if  they  were  naked  nuclei,  though 
by  Golgi's  method  it  can  be  shown  that  they  may  possess  definite 
axones  and  dendrites.  In  some  of  these  cells  the  stainable  sub- 
stance may  be  present,  but  very  unevenly  distributed,  at  different 
points  in  the  cell,  the  nucleus  appearing  as  if  only  partially  sur- 
rounded by  protoplasm.  Nissl  classifies  these  cells  with  such  an 
ill-defined  cell-body,  the  nucleus  appearing  only  partially  sur- 
rounded and  not  exceeding  in  size  the  nucleus  of  a  neuroglia  cell 
or  of  an  ordinary  leucocyte,  as  "granules"  (Korner)  or  cyto- 
chrome nerve  cells.  These  cells  are  present  in  great  numbers  in 
the  granular  layer  of  the  cerebellum,  also  in  the  cerebral  cortex 
and  the  olfactory  bulb — ^being  different  varieties  and  not  identical. 
The  second  subgroup  of  cells,  in  which  the  cell-body  is  only  indi- 
cated but  the  nucleus  is  of  the  size  of  an  ordinary  nerve  cell,  or 
at  least  larger  than  that  of  a  neuroglia  cell,  he  designates  as 


8  G.  ALFRED  LAWRENCE. 

caryochrome  nerve  cells.  There  are  varieties  of  these  as  in  the 
substantia  gelatinosa  Rolando,  and  those  of  the  ganglion  ha- 
benula — these  types  being  designated  at  present  by  letters  of  the 
Greek  alphabet.  A  majority  of  the  nerve  cells  fall  in  the  first 
group — the  somatochrome  cells — w^here  the  cell-body,  in  the  light 
of  morphology,  has  apparently  greater  relative  importance  than 
the  nucleus.  In  this  group  are  a  series  of  types  of  nerve  cells  to 
be  distinguished  from  one  another  partly  through  differences  in 
the  nuclei,  but  chiefly  through  different  relations  of  the  stainable 
and  unstainable  constituents  of  the  cell-body. 

These  somatochrome  cells  were  originally  divided  by  Nissl 
into  four  groups,,  but  now  he  includes  them  all  in  three  groups  as 
follows : 

Group  I.  Arkyochrome  nerve  cells: — stainable  portions  of 
cell-body  in  Nissl  preparations  in  the  form  of  a  network,  branches 
of  which  appear  to  be  distinctly  connected.  Nissl  notes,  however, 
that  in  many  of  these  cells  processes  can  be  made  out  into  which 
the  distinct  network  of  the  perinuclear  part  of  the  cell-body  can 
go  over,  thus  forming  a  parallel-striped  arrangement.  These 
arkyochrome  cells  Nissl  subdivides  into  enarkyochrome  forms 
and  ampharkyochrome  forms.  The  former  shows  the  stained 
constituents  arranged  in  the  form  of  a  network,  which  differs 
from  the  latter  in  that  the  intensely  stained  radiating  nodal  points 
of  the  network  are  connected  in  the  cell-body  by  deeply  stained 
thick  bridges  so  that  a  further  connected  network  of  very  deeply 
stainable  substances  is  observable.  Both  these  sub-groups  of 
cells  are  widel}^  distributed  throughout  the  central  nervous  sys- 
tem. The  former  have  been  observed  by  Nissl  in  the  spinal  cord, 
but  are  most  numerous  in  the  large  dorsal  nucleus  at  the  proximal 
end  of  the  medulla.  What  he  formerly  classified  as  Group  III, 
arkyostichochrome  nerve  cells,  are  now  included  in  this  first 
group  (1897a).-  He  describes  these  cells  as  presenting  a  striated 
appearance  with  a  network-like  structure  united  in  a  most  intricate 
manner. 

The  Purkinje  cells  of  the  cerebellar  cortex  were  given  as  typi- 
cal examples  of  cells  of  this  sort.     (See  Plate  IX,  Fig.  27). 

Group  II.     Stichochrome  nerve  cells,  stainable  substance  ar- 


DEMENTIA  PARALYTICA.  9 

ranged  in  strise,  running  in  same  direction,  and  usually  parallel 
to  contour  of  cell-body,  in  part  also  with  surface  of  nucleus. 
These  strise,  made  up  of  different  stained  elements,  threads,  spin- 
dles and  granules,  are  more  or  less  isolated  and  in  rows.  Nissl 
describes  four  types  of  these  cells  represented  by  (i)  nerve  cells 
of  motor  nuclei,  (2)  large  cells  of  cornu  Ammonis,  (3)  certain 
cells  of  cerebral  cortex,  and  (4)  certain  cells  of  spinal  ganglia. 

Group  III.  Gryochrome  nerve  cells,  stainable  substance  en- 
tirely made  up  of  small  granules  distributed  in  threads  or  heaps. 
Nissl  does  not  give  an  illustration  of  these  cells,  but  states  that 
they  are  to  be  found  particularly  but  not  exclusively  in  the  corpus 
striatum.  Nissl  states  further  that  transitional  forms  exist  which 
are  difficult  to  definitely  classify,  but  that  the  cells  of  a  wholly 
definite  structure  are  situated  throughout,  the  animal  series  in 
homologous  localities.  He  has  also  shown  that  all  these  types  of 
cells  may,  under  certain  circumstances,  show  different,  staining 
relations  (1894a),  that  is,  the  individual  members  of  a  certain 
group  of  cells  belonging  to  one  type  .may  be  palely,,  moderately, 
or  intensely  stained.  This  difference  seems  to  depend  upon  the 
concentration  of  the  stainable  substance  in  the  cell-body.  The 
darkly  stained  ceils  he  designates  as  pyknomorphous  cells,  in 
which  stainable  portions  are  arranged  relatively  most  closely ; 
intermediate  stages  are  designated  as  parapyknomorphous  cells ; 
while  very  feebly  stained  cells  are  designated  as  apyknomor- 
phous,  in  which  stainable  masses  are  not  arranged  close  to  one 
another  but  are  somewhat  widely  separated  by  the  non-stainable 
constituents  of  the  cell-body.  Nissl  furthermore  mentions  that 
often  the  nucleus  shows  modifications  which  correspond  in 
greater  or  less  degree  to  the  staining  intensity  of  the  cell-body, 
so  that  in  an  apyknOmorphous  cell  the  unstained  nuclear  sub- 
stance is  relatively  more  abundant  than  in  the  pyknomorphous 
cells.  This  holds  in  the  somatochrome  cells,  and  to  a  less  degree 
in  the  caryochrome  and  cytochrome  cells. 

Supposed  to  be  more  or  less  in  the  nature  of  an  artefact  are 
the  so-called  chromophile  nerve  cells  which  one  finds  often  single 
or  in  small  groups  along  with  the  other  nerve  cells,  but  in  which 
the  stainable  substance  seems  to  be  evenly  diffused  throughout 


lO  G.  ALFRED  LAWRENCE. 

the  cell-body,  making  it  impossible  to  distinguish  a  stainable  from 
an  unstainable  constituent  in  the  cell.  Nissl  (1896c)  states  that 
they  are  always  relatively  smaller  than  pyknomorphous  cells.  The 
explanation  of  these  forms  is  not  as  yet  entirely  satisfactory,  but 
they  are  supposed  to  be  due  to  the  action  of  the  reagents  em- 
ployed, though  under  certain  circumstances  they  may  have  a 
pathological  significance.  Another  nomenclature  has  been  intro- 
duced by  Flesch  (1897),  in  which  he  speaks  of  chromophilic  cells 
and  chromophobic  cells  with  transitional  forms,  and  attributes  the 
differences  to  variations  in  the  internal  chemistry  of  the  cells,  this 
latter  depending  in  part  upon  differences  in  the  devolopment,  in 
part  upon  differences  in  metabolism  or  function. 

Von  Lenhossek  (1895)  gives  a  very  accurate  description  of 
the  appearances  within  the  cells  of  the  ventral  horn  of  the  spinal 
cord  and  in  the  cells  of  the  spinal  ganglia.  He  has  found  that 
thionin  stains  as  well  if  not  better  than  methylene  blue,  and 
Barker  (1899)  has  obtained  similar  results,  but  states  that  crys- 
talline deposits  have  been  more  frequent  in  preparations  stained 
with  thionin  than  in  those  stained  with  methylene  blue.  In  ma- 
terial hardened  in  Lang's  solution  or  other  corrosive  sublimate 
solutions,  the  writer  has  at  times  detected  crystalline  deposits, 
whether  stained  with  thionin,  methylene  blue  or  methylene  violet, 
and  attributed  the  same  to  the  fixative  fluid  and  not  to  the  stain 
at  all,  as  no  crystalline  deposits  have  been  observed  with  other 
fixative  agents-— alcohol,  formalin,  and  Van  Gehuchten's  fluid- 
regardless  of  which  stain  was  used. 

It  would  be  interesting  to  know  whether  corrosive  sublimate 
fixation  was  used  by  Barker  in  the  above  mentioned  preparations. 
Van  Gieson  uses  polychrome  to  a  considerable  extent  as  a  stain, 
but  it  seems  to  the  writer  to  give  a  paler  and  less  distinct  stain 
than  either  methylene  blue  or  methylene  violet,  and  has  a  tend- 
ency to  fade  after  a  time.  Referring  to  von  Lenhossek  again,  he 
objects  to  the  term  "granules"  for  the  stainable  substance,  the 
masses  being  ordinarily  much  too  coarse  to  be  so  designated.  He 
has  given  accurate  descriptions  of  their  characteristics  and  ar- 
rangement in  various  animal  species.  This  stainable  substance  of 
Nissl  he  designates  as  "chromophile  corpuscles,"  and  later  uses 
the  term  "tigroid  masses"  (1896). 


DEMENTIA  PARALYTICA.  II 

Do  Quervain  (1893)  has  suggested  that  the  chromophiUc 
bodies  or  corpuscles  are  aggregations  of  fine  granules,  but  von 
Lenhossek  refuses  to  admit  that  all  such  bodies  represent  aggre- 
gations of  minute  granules.  Schaft'er  (1893)  first  described  the 
peculiar  behavior  of  the  axone  and  adjacent  portion  of  the  cell- 
body  known  as  the  axone  hillock  as  regards  Nissl  staining,  this 
space  being  entirely  free  from  this  stainable  substance  of  Nissl. 
With  Kronthal's  method  the  axone  and  axone  hillock  stain  in- 
tensely in  methylene  blue,  but  Benda  (1895)  found  that  when 
specimens  thus  prepared  were  cleared  in  creosote  this  region  lost 
its  color  and  only  the  stainable  substance  of  Nissl  in  the  cell-body 
and  dentrites  retained  its  color.  He  found  one  exception,  how- 
ever. In  the  basal  axones  of  the  pyramidal  cells  of  the  cerebrum, 
especially  of  those  known  as  the  giant  pyramidal  cells  of  Betz,  just 
at  the  beginning  where  a  collateral  is  coming  off  at  right  angles, 
a  small  wedge-shaped  granule,  triangular  in  section,  takes  up  the 
methylene  blue,  the  axone  itself  not  staining  at  all.  These  dif- 
ferent results  obtained  by  differences  in  technique  emphasize  the 
writer's  previous  statement  of  the  necessity  of  a  full  knowledge 
of  the  history  of  the  case  and  every  detail  of  technique  before  com- 
ing to  any  conclusions  in  a  given  case. 

With  this  brief  review  of  the  more  important  literature  on  the 
internal  structure  of  the  nerve  cell  we  will  now  turn  to  the  ar- 
rangement of  the  cells  in  the  cortex.  To  go  into  the  literature  of 
this  subject  in  detail  would  be  sufficient  material  for  an  article  in 
itself,  so  that  it  will  be  passed  over  as  briefly  as  possible.  Table  I 
shows  the  arrangement  of  the  cells  as  described  by  the  more  im- 
portant contributors  to  this  subject.  As  early  as  1782  Gennari 
divided  the  cortex  at  the  posterior  pole  of  the  cerebrum  into  three 
layers,  an  external  and  internal  gray  layer  separated  by  a  white 
layer  (so-called  line  or  band),  the  "line  of  Gennari."  Vicq  d'Azyr, 
in  1786,  described  this  region  as  also  made  up  of  an  inner  and 
outer  gray  layer  between  which  was  a  white  layer  (line  or  band), 
the  "line  of  Vicq  d'Azyr."  Meckel,  in  1812,  stated  that  the  gray 
layer  of  the  cortex  is  single  in  all  parts  but  the  occipital  region  and 
cornu  Ammonis.  In  the  occipital  region  a  band  of  white  substance, 
the  line  of  Vicq  d'Azyr,  separates  the  gray  substance  into  an 


12  G.  ALFRED  LAWRENCE. 

external  and  internal  gray  layer,  so  that  the  structure  of  this 
part  of  the  brain  is  more  complex  than  the  rest  of  the  external 
cortical  region.  Coming  down  to  1840  Baillarger  first  examined 
the  cortex  carefully,  and  described  three  gray  and  three  white 
layers,  or  six  layers  in  all,  alternating  gray  and  white.  From  his 
descriptions  the  line  of  Gennari  or  Vicq  d'Azyr,  in  the  occipital 
region,  received  the  additional  name  of  the  "line  of  Baillarger." 
In  1841  Remak  examined  the  cortex  microscopically  as  well  as 
macroscopically,  but  without  the  use  of  staining  agents,  and  de- 
scribed a  four-layered  type  made  up  of  two  gray  and  two  white 
layers  alternating  with  one  another. 

Somewhat  later  (1852)  Kolliker  described  a  three-layered 
plan,  the  inner  layer  appearing  of  a  yellowish  red  color,  the  mid- 
dle of  a  grayish  color,  and  the  outer  of  a  whitish  color. 

Berlin,  in  1858,  first  used  stains  in  his  work,  hardening  pieces 
of  the  cortex  in  chrome  salt  and  staining  with  carmine.  He  de- 
scribed six  layers  as  the  type,  the  upper  five  from  the  character 
and  arrangement  of  the  cells  and  the  lower  as  a  layer  free  from 
cells.  He  describes  the  layers  from  within  outwards  toward  the 
surface,  reversing  the  usual  order  of  all  other  authors,  and' lead- 
ing to  considerable  confusion,  unless  this  fact  is  carefully  noted. 
Clarke,  in  1863,  described  eight  layers  as  the  common  type,  and 
Luys  the  following  year,  1864,  described  just  one  half  that  num- 
ber, or  four  layers,  as  the  common  type.  Arndt,  in  1867,  de- 
scribed a  five-layered  type,  and  Meynert  in  the  same  year  divided 
the  cortex  into  a  motor  and  a  sensory  region,  the  former  anterior 
to  the  fissure  of  Rolando,  and  the  latter  posterior  to  the  same. 
He  described  five  layers  as  the  common  type,  and  eight  layers  as 
the  type  in  the  occipital  region.  Cleland,  in  1870,  described 
rather  a  complex  arrangement  of  the  cortex  into  a  four-layered 
type,  the  third  layer  being  separated  from  the  fourth  by  what  he 
designated  as  the  "primary  pale  band."  The  "deep  pale  band" 
is  included  in  and  forms  the  lower  part  of  the  fourth  layer. 
Henle  in  the  same  year  described  a  four-layered  type  made  up  of 
(i)  the  outer  layer,  (2)  outer  spherical  cell  layer,  (3)  pyramidal 
cell  layer,  and  (4)  inner  spherical  cell  layer.  Charcot,  the  fol- 
lowing year,  1871,  described  the  layers  of  the  cortex  as  five  in 


DEMENTIA  PARALYTICA.  1 3 

number,  (i)  superficial  layer,  (2)  small  pyramidal  cell  layer, 
(3)  larger  pyramidal  cell  layer,  (4)  granular  cell  layer,  and 
(5)  fusiform  cell  layer;  approximating  that  used  by  many  of  the 
subsequent  authors.  Lewis,  in  1876,  described  five  layers  as  the 
type  for  the  motor  area  and  six  layers  as  the  type  for  the  sensory 
area.  Major  in  the  same  year,  1876,  described  six  layers  as  the 
common  type,  and  Krause,  also  in  the  same  year,  described  seven 
layers  as  the  common  type.  Betz,  in  1881,  made  the  division  into 
five  layers  as  the  type  for  the  motor  area,  but  divided  the  sensory 
region  into  eight  layers  as  the  type — a  classification  somewhat 
similar  to  Meynert's,  but  with  a  different  nomenclature. 

Golgi,  in  1883,  using  his  impregnation  method,  divided  the 
cortex  into  three  layers  as  the  type,  (i)  superficial  or  small 
pyramidal  cell  layer,  (2)  middle  .or  larger  pyramidal  cell  layer, 
and  (3)  internal  or  irregular  cell  layer.  Schwalbe,  in  1885,  de- 
scribed a  curious  arrangement  of  the  cortex  into  four  layers,  the 
upper  two  known  as  the  "outer  Hauptzone"  or  chief  zone,  and 
separated  from  the  lower  into  two  layers,  known  as  the  "inner 
Hauptzone"  or  chief  zone, by  the  "boundary  zone"  or  "line  of 
^aillarger;"  Obersteiner's  (1887)  division  into  a  five-layered 
•type  is  similar,  except  as  to  the  nomenclature,  to  that  of  Char- 
cot's common  type,  Lewis'  motor  type,  and  Betz's  motor  type. 
Cajal,  in  1890,  recognized  the  same  three  layers  as  Golgi  in  the 
.common  type,  but  added  a  fourth  layer,  which  he  called  the  first 
or  molecular  zone,  then  followed  the  second,  or  zone  of  small 
pyramidal  cells ;  the  third,  or  zone  of  large  pyramidal  cells,  and 
•the  fourth,  or  zone  of  polymorphous  cells ;  thus  making  four 
layers  in  all.  Golgi's  first  layer  is  thus  seen  to  include  the  first 
and  second  layers  of  Cajal.  In  the  occipital  lobe,  Cajal  describes 
an  additional  layer  of  vertical  fusiform  cells  between  the  first  or 
molecular  layer  and  the  layer  of  small  pyramidal  cells,  the  other 
layers  being  similar  to  his  common  type,  and  thus  making  fi:ve 
layers  in  this  region.  Gowers,  in  1893,  adopted  practically  the 
same  division  into  a  five-layered  motor  type  and  six-layered  sen- 
sory type  as  described  by  Bevan  Lewis  in  1876.  Hammarberg, 
in  1895,  described  six  layers  as  the  type,  with  numerous  varia- 
tions in. different  parts  of  the  cortex.    Edinger,  in  1896,  describes 


14  G.  ALFRED  LAWRENCE. 

four  layers,  similar  to  Cajal  as  the  type,  and  Starr  (1896),  in 
his  atlas  of  nerve  cells,  also  describes  a  similar  arrangement. 
Nissl  (1898)  describes  a  four-layered  type  as  follows:  First,  or 
layer  poor  in  cells ;  second,  or  layer  of  pyramidal  cells  containing 
2  equals  layer  of  small  pyramidal  cells  (equals  2  of  Meynert's 
layers)  plus  3  equals  layer  of  larger  pyramidal  cells  (equals  3  of 
Meynert's  layers)  ;  third,  or  layer  of  small  cells  (equals  4  of 
Meynert's  layers)  ;  and  fourth,  or  internal  (6)  plus  external  (5) 
zone  of  the  layer  of  medullated  fibers  (equals  5  of  Meynert's 
layers).  Region  5  equals  ganglion  cell  layer,  and  region  6  equals 
spindle  cell  layer  of  Hammarburg.  It  will  be  seen  that  there  is 
much  variation  and  not  a  little  confusion  in  adjusting  these 
various  arrangements  and  classifications  to  one  another,  and  in 
order  to  simplify  the  matter  as  much  as  possible  the  writer  sug- 
gests that  as  the  large  and  small  pyramidal  cells  are  so  inter- 
mingled and  merged  into  one  another,  they  should  be  included 
in  one  layer,  thus  making  three  layers  the  common  type,  as  fol- 
lows :  First,  or  superficial  layer,  corresponding  to  the  first  layer 
of  Cajal  and  Edinger;  second,  or  pyramidal  cell  layer,  corre- 
sponding to  the  second  and  third  layers  of  Cajal  and  Edinger; 
and  third,  or  spindle  cell  layer,  similar  to  the  fourth  layer  of 
Cajal  and  Edinger.  This  arrangement  differs  from  Golgi's  three- 
layered  type  in  that  the  latter  recognized  no  superficial  or  tangen- 
tial fiber  layer,  but  includes  this  as  the  upper  part  of  his  first,  or 
layer  of  small  pyramidal  cells,  whereas  in  the  writer's  arrange- 
ment one  pyramidal  cell  layer  includes  both  the  large  and  small 
pyramidal  cell  layers  of  Golgi.  The  third  layer  ,of  Golgi  and  of 
the  writer  are  the  same  as  the  fourth  layer  of  Cajal  and  Edinger. 
This  classification  into  three  layers  as  the  type  will  be  used  for 
convenience  in  the  subsequent  description  of  the  plates.  That 
there  are  variations  from  the  type  in  difiPerent  parts  of  the  cOrtex, 
of  course,  is  recognized  by  all  who  have  worked  in  this  field  to 
any  extent,  and,  furthermore,  specialized  parts  of  the  cortex  have 
a  specialized  arrangement,  as  the  cornu  Ammonis,  for  example. 

In  turning  now  to  the  pathological  investigations  by  means 
of  the  Nissl  stain  (1898),  they  are  found  to  have  been  exhaustive 
and  varied,  including  most  parts  of  the  central  nervous  system 


DEMENTIA  PARALYTICA.  1 5 

in  both  man  and  animals  and  in  many  forms  of  disease.  A  brief 
review  only  will  be  given  of  the  contributions  containing  descrip- 
tions of  researches  by  Nissl's  stain  in  that  form  of  mental  de- 
rangement known  as  dementia  paralytica,  or  general  paresis. 
Nagy  (1894)  carried  on  his  investigations  by  means  of  the  Nissl 
stain,  and  found  the  greatest  changes  in  dementia  paralytica,  in- 
cluding various  stages  of  cell  degeneration  up  to  complete  de- 
struction of  the  same — the  cells  most  altered  being  those  of  the 
frontal  lobes,  and  least  changed  those  of  the  occipital  lobes. 
Changes  of  a  high  grade  were  also  shown  in  the  cells  of  cases 
dying  after  severe  epileptic  insanity — here  the  gyrus  rectus  and 
cornu  Ammonis  being  affected  the  most.  In  chronic  forms  of  in- 
sanity similar  changes  were  found,  but  the  number  of  cells  en- 
tirely destroyed  was  undoubtedly  smaller  than  in  the  above  men- 
tioned forms  of  illness.  In  acute  hallucinatory  confusional 
insanity  only  the  beginning  stages  of  alteration  were  found ;  simi- 
larly in  mania.  He  finally  states  that  each  form  of  mental  de- 
rangement showed  the  highest  grade  of  change  in  which  the 
clinical  picture  of  the  worst  suffering  was  present,  while  in  the 
curable  forms  there  were  found  corresponding  slight  changes. 
Belmondo  (1896)  employed  the  Nissl  method  in  investigating 
the  alterations  in  the  nerve  cells  in  dementia  paralytica,  and  did 
not  find  changes  of  great  gravity — at  most  the  cell  protoplasm 
being  much  diminished  and  disintegrated  5  now  and  then  pigmen- 
tary atrophy,  as  much  in  the  Rolandic  region  as  the  frontal  lobe, 
is  found,  and  in  other  parts  a  diffuse  chromatolysis  is  to  be  seen. 
He  condemns  the  expression  meningo-peri-encephalitis,  which  im- 
plies a  conception  of  an  inflammatory  process. 

Boedecker  and  Juliusburger  (1897)  examined  sections  of 
cortex  from  the  central  and  parietal  convolutions  of  three  cases 
of  dementia  paralytica  by  the  Nissl  method.  They  found  thick- 
ening of  the  pia  with  septa  projecting  into  the  cortex,  containing 
blood  vessels  whose  walls  showed  no  special  thickening  but  were 
surrounded  by  rich  deposits  of  pigment  granules,  which  latter 
were  also  found  here  and  there,  distant  from  the  septa  in  the 
cortical  network.  In  regions  most  affected  the  cortex  did  not 
present  its  well  known  layering.    There  was  to  be  seen  a  thickly- 


1 6  G.  ALFRED  LAWRENCE. 

compressed  granular  crowding  with  different  shaped  granules ; 
thin,  spindle-shaped,  round,  or  oval,  with  strongly  colored  ones 
lying  adjacent  to  those  only  slightly  colored.  There  was  increase 
of  blood  vessels  and  hypertrophy  of  the  interstitial  network,  with 
corresponding  decrease  in  the  number  and  size  of  the  cells. 
Many  cells  were  considerably  diminished  in  size,  markedly 
shrunken,  entirely  without  processes,  and  intensely  colored.  At 
times  a  differentiation  into  nucleus  and  granular  cell-body  was 
not  possible,  owing  to  complete  chromatolysis,  and  very  seldom 
were  cells  found  with  a  strongly  colored  nucleus,  strongly  colored 
fine  granules  about  the  same,  with  larger  granules  at  the  peri- 
phery of  the  cell-body — a  partial  chromatolysis. 

By  the  Marchi  method  these  investigators  determined  a  de- 
generation of  the  fibers  from  these  cells  extending  into  the  spinal 
cord.  They  conclude  the  process  to  be  an  intense  degeneration 
and  proliferating  one,  going  on  hand  in  hand — degeneration  of  the 
cells  and  proliferation  of  the  interstitial  network,  with  increase  of 
blood  vessels.  Crisafulli  (1897)  notes  a  great  variety  of  changes 
in  dementia  paralytica.  The  cellular  changes  are  most  advanced 
and  diffuse  in  the '  frontal  lobes,  but  are  not  limited  to  that 
region.  He  examined  sections  from  the  frontal,  parietal,  occipi- 
tal and  temporo-sphehoidal  lobes  of  both  hemispheres.  He  found 
pallor,  granular  disintegration,  and  loss  of  chromatic  substance. 
Often  the  cell-bodies  were  atrophied  or  contained  an  excess  of 
yellowish  pigment,  and  their  numbers  were  reduced.  The  nuclei 
were  often  eccentric,  and  all  stages  of  the  destruction  of  the 
nucleus  were  observed.  While  the  alterations  shown  by  Nissl's 
method  were  not  less  constant  than  those  demonstratable  by  other 
methods,  Crisafulli  does  not  consider  them  characteristic  of  the 
disease  or  in  any  way  different  from  those  seen  in  some  other 
mental  diseases.  They  are,  however,  more  or  less  grave  and 
diffuse  and  not  limited  to  a  single  cortical  center;  with  varying 
degrees  of  degeneration  of  the  nerve  cells.  He  further  states 
that, -provided  the  nerve  cell  element  degeneration  is  not  greatly 
advanced,  it  is  impossible  to  find  any  alteration  of  the  blood  ves- 
sels, and,  finally,  that  when  the  psychosomatic  condition  of  the 
paralytic  is  not  greatly  aggravated  and  death  intervenes   from 


DEMENTIA  PARALYTICA.  tj 

Other  causes,  it  is  possible  that  the  pathological  report  will  note 
some  elements  which  are  not  degenerated,  although  there  may  be 
various  alterations.  His  article  is  illustrated  by  eight  figures 
showing  cells  in  various  conditions  of  degeneration, 

Angladi  (1898)  reports  a  case  of  acute  dementia  paralytica 
in  which  death  occurred  after  a  series  of  epileptiform  convulsions 
when  the  patient  was  at  the  age  of  thirty-seven  years.  The 
autopsy  showed  peri-encephalitis.  Preparations  were  made  from 
the  ascending  frontal  convolutions  and  the  anterior  part  of  the 
frontal  lobe  of  the  left  hemisphere.  He  states  that  not  a  single 
one  of  the  pyramidal  cells  preserved  its  normal  characteristics, 
and  the  transformation  in  the  great  majority  of  cases  semed  to 
be  various  stages  of  the  same  process — various  stages  of  chro- 
matolysis,  vacuolization,  eccentricity  of  the  nucleus  up  to  rupture 
of  the  cell  wall  and  extrusion  of  the  nucleus  and,  finally,  com- 
plete destruction  and  disappearance  of  the  cell.  The  chromatic 
substance  is  first  attacked,  and  some  few  cells  relatively  healthy 
showed  about  the  nucleus  the  first  stages  of  dissolution.  De- 
struction of  the  achromatic  network  was  shown  by  formation  of 
vacuoles  at  the  periphery  of  the  cell,  increasing  gradually  up  to 
complete  destruction  of  the  substance  of  the  cell.  The  nucleolus 
becomes  vacuolated  and  disappears.  The  nucleus  is  attacked 
by  central  chromatolysis  and  disappears  in  situ,  or  becomes 
eccentric,  or  the  cell-body  may  rupture  and  the  nucleus  be  ex- 
truded, becoming  irregular,  compressed  or  shriveled.  The  con- 
tour of  the  cells  is  always  irregular,  and  the  prolongations  either 
broken  or  tortuous.  He  states  that  the  cells  of  the  medulla  and 
cord  show  identical  alterations.  Angladi  finally  concludes  by 
stating  that  we  do  not  know  whether  these  lesions  are  the  cause 
or  the  result  of  the  malady,  and  asks  the  question,  "Are  the 
lesions  primary  or  secondary  to  an  alteration  of  the  vessels  or 
interstitial  tissue?" 

Berger  (1898)  examined  the  anterior  horn  cells  of  the  spinal 
cord  in  twelve  cases  of  dementia  paralytica  and  found  lesions 
affecting  principally  the  chromatic  substance  in  83  per  cent  of 
the  cases.  He  failed  to  find  a  strict  parallel  between  these  cellu- 
lar lesions  and  those  of  the  fibers  and  cortex,  or  between  them 


1 8  G.  ALFRED  LAWRENCE. 

and   the   clinical   symptoms   of  the   disease.     He  illustrates   his 

article  by  figures  of  these  cells. 

Nissl  (96a),  in  1896,  stated  that  he  maintains  the  same  posi- 
tion as  Kraepelin,  namely,  that  one  sees  in  dementia  paralytica  a 
general  disease  with  the  histopathology  directed  especially  to  the 
cortex.  The  pathological  changes  in  the  blood  vessels  are  obscure, 
and  the  relation  of  the  glia  to  the  blood  vessels  is  complicated, 
also  the  condition  of  the  lymphatic  vessels.  Sorne  authors  regard 
the  disease  as  an  inflammatory  process,  others  that  a  chronic  in- 
terstitial inflammation  enters  into  it,  others  that  it  is  a  parenchy- 
,  matous  process,  and  still  others  that  it  is  a  histopathological  pro- 
cess in  which  the  specific  tissue  is  diseased  primarily.  Nissl  notes 
that  an  inflammation  without  the  blood  vessels  sharing  in  it  can- 
not be  thought  of.  He  states  that  the  appearance  of  the  paralytic 
cortical  disease  can  be  present  without  the  blood  vessels  being 
diseased  and  without  the  blood  vessels  containing  any  elements, 
of  an  inflammatory  process.  Also  there  may  be  a  high  grade  of 
disease  of  the  'tissue  (Gewebe)  in  excess  of  any  disease  of  the 
blood  vessels,  and  only  a  slight  involvement  of  the  tissue,  and 
vice  versa,  a  severe  tissue  damage  with  only  insignificant  disease 
of  the  blood  vessels.  Also  direct  inflammatory  blood  vessel 
changes  with  infiltration  of  the  walls  of  the  same  with  leucocytes 
and  "mastzellen,"  which  may  rarely  pass  out  into  the  adjacent 
regions.  In  some  cases  this  inflarnmatory  alteration  of  blood  ves- 
sels results  in  a  massive  production  of  decay  of  numerous 
neurones.  These  inflammatory  changes  in  the  blood  vessels  have 
nothing  directly  to  do  with  the  chief  paralytic  process,  and  are 
only  found  in  the  cortex  when  sepsis-producing  bacteria  are 
present.  It  therefore  follows  that  the  paralytic  cortical  disease 
can  be  regarded  either  as  the  result  of  disease  of  the  blood  vessels 
or  as  an  inflammatory  process.  Almost  all  cases  of  dementia 
paralytica  show  a  slight  or  severe  disease  of  the  blood  vessels. 
There  may  be  also  a  leptomeningitis,  disease  of  the  beginning 
part  of  the  aorta,  an  injury  to  the  diploe,  brittleness  of  the  bones, 
or  there  may  be  a  general  arterio-sclerosis.  If  it  is  not  a  disease 
of  the  arteries  or  an  inflammatory  process,  it  may  be  a  primary 
disease  of  the  glia  or  of  the  cortical  neurone.     Changes  in  glia 


DEMENTIA  PARALYTICA.  I9 

are  progressive  in  kind  (mitosis  of  glia  nuclei,  hypertrophy  of 
gha  cells,  and  increase  of  glia  fibers)  with  regressive  changes  in 
.the  cortical  neurone — an  acceptation  that  results  of  investigation 
directly  contradict,  since  we  find  in  the  most  luxuriant  increase 
of  glia  that  the  nerve  cells  are  only  slightly  or  not  at  all  changed, 
and  vice  versa,  in  the  most  severe  nerve  cell  changes  the  increase 
of  glia.  may  be  only  slight.  The  acceptation  of  a  primary  glia 
fiber  increase  is  absurd,  since  the  glia  fibers  are  an  intercellular 
substance.  Nissl  therefore  concludes  that  the  cortical  disease  of 
dementia  paralytica  is  a  primary  disease  of  the  cortical  neurone ; 
at  the  same  time  with  the  regressive  changes  in  the  cortical  neu- 
rone goes  the  progressive  changes  in  the  glia  cells..  Histo- 
pathological  investigations  of  paralytic  cortical  disease  has  to  deal 
chiefly  with  the  following  difficulties :  ( i )  a  paralytic  diseased 
cortex  and  the,  to  us,  available  cortex  of  the  dead  paralytic  are 
two  different  things.  Entire  series  of  original  circumstances  that 
damage  the  neurones  of  the  cortex  without  having  anything  to 
do  directly  with  the  paralytic  process  is  to  be  noted,  as  the  com- 
plete closure  of  a  blood  vessel  which  only  indirectly  bears  upon 
the  original  process.  Also  death  of  a  paretic  froni  typhus  fever, 
septic  pyemia,  etc.  The  problem  is  extremely  difficult,  as  there 
is  no  specific  disease  of  the  cortical  cells,  and,  furthermore,  there 
is  no  paralytic  cortical  cell  disease,  although  there  is  a  paralytic 
cortical  disease.  The  kind  of  disease  of  the  cortical  tissue  is 
worthy  of  being  pointed  out.  (2)  It  is  not  sufficient  to  know  that 
the  cortical  neurone  is  diseased,  but  it  is  important  to  know 
which  cortical  neurones  are  damaged.  ■  Attention  to  the  kinds  of 
nerve  cells  directly  diseased  is  important  for  the  real  conception 
of  the  disease  process,  and  also  for  the  critical  examination  of  the 
plan  of  the  cortex  and  its  functions. '  Nissl  differentiates  the 
following  forms  of  disease  of  the  cells  of  the  cortex  in  dementia 
paralytica :  ( i )  Acute  progressive  disease.  In  certain  cases  the 
disease  ends  with  the  complete  destruction  of  the  elements  of  the 
cortex.  (2)  The  chronic  disease  progresses  slowly,  restilting  in 
either  a  pigmentary  degeneration  or  in  a  decay  of  the  cell-body 
and  nucleus,  and  ends  with  so-called  cell  sclerosis.  (3)  The 
severe  disease  of  the  cortex  which  runs  either  an  acute  or  sub- 


20  G.  ALFRED  LAWRENCE. 

acute  course  and  terminates  with  the  death  of  the  cell.  The 
necrotic  cells  persist  commonly  either  bleached  out  or  having  the 
appearance  of  colliquation  or  of  vaucolization  of  the  ground  work. 
(4)  The  combined  form  of  the  disease,  in  which  the  cell  may  be 
acutely  diseased  without  either  a  cure  following,  or,  on  the  other 
hand,  the  ordinary  course  being  taken  that  terminates  with  the 
destruction  of  the  cell.  Midway  in  its  course  the  disease  process 
is  arrested  and  takes  on  the  symptoms  of  the  chronic  disease.  The 
severe  cortical  cell  disease  is  entirely  overlooked  by  former 
authors.  It  differs  in  that  the  nucleus  is  also  involved  and  a  pro- 
cess of  liquefaction  takes  place  in  the  same.  It  becomes  smaller, 
shrunken,  the  contours  become  homogeneous  and  tinged,  the  nu- 
cleolus sinks  to  the  nuclear  wall,  which  latter  is  irregular  and 
shriveled  into  folds,  the  network  cannot  be  distinguished,  and 
vacuoles  and  crystals  may  be  formed.  In  the  necrotic  cells  cal- 
careous deposits  may  be  found,  as  is  seen  in  other  cortical  cell 
diseases,  as  sclerotic  elements.  These  chalky  or  calcareous  con- 
cretions occur  in  the  form  of  fine  granules,  crumbs,  placques,  or 
stalactitic  masses,  which  are  intensely  colored  with  methylene 
blue.  The  entire  cell  may  be  bleached  or  only  a  single  part,  as 
some  of  the  fine  dendrites  or  only  a  single  dendritic  process,  or  only 
the  nucleus,  or,  finally,  only  the  nucleur  membrane.  This  calcifi- 
cation, moreover,  is  an  exceedingly  important  phenomena,  since 
we  are  entitled  to  conclude  that  partially  calcified  cells  are  no 
longer  functionally  active  and  are  necrotic.  Under  similar  condi- 
tions in  acute  diseases  we  recognize  the  phenomenon  of  death  in 
the  affected  cells.  If  one  places  the  preparations  in  alcohol  after 
twelve  hours  postmortem,  any  mistake  in  this  direction  may  be 
obviated.  Whoever  grasps  the  histopathology  of  the  cortical  cells 
will  guard  against  any  mistake  in  regard  to  the  above  mentioned 
death  phenomena.  Ewing,  in  1898,  used  the  Nissl  method  in 
observations  upon  the  changes  found  in  ganglion  cells  of  the  cen- 
tral nervous  system  in  various  pathological  conditions,  and  stated 
that  various  grades  of  chromatolysis  were  found  in  the  cortical 
cells  in  dementia  paralytica. 

Ballet  (1898)  exhibited  sections  from  the  paracentral  lobule 
of  both  a  normal  and  a  paretic  brain,  stained  by  the  Nissl  method. 


DEMENTIA  PARALYTICA.  21 

In  the  normal  brain,  under  a  magnification  of  forty-five  diameters, 
the  four  layers  of  Schwalbe  and  Ramon  y  Cajal  were  easily  dis- 
coverable, but  in  the  paretic  sections,  in  marked  contrast,  they 
were  recognized  with  difficulty ;  also  in  the  latter,  great  numbers 
of  capillaries  were  noted  in  the  third  layer  and  white  subcortical 
substance,  the  nerve  cells  were  less  numerous,  and  in  all  cases  less 
distinct  and  lost  in  the  midst  of  a  mass  of  nuclei.  At  130  diame- 
ters the  contrast  was  still  more  marked,  and  at  250  diameters 
vascular  lesions  were  noted  consisting  of  enormous  dilatation  of 
the  capillaries  and  arterioles,  the  investment  of  these  vessels  by  a 
casing  of  lymphatic  corpuscles  which  distended  the  adventitious 
sheaths,  and  the  accumulation  of  pigment  at  certain  points,  par- 
ticularly in  the  neighborhood  of  the  bifurcations.  These  altera- 
tions are  also  revealed  by  hematoxylin  and  picro-carmine,  and 
have  been  described  for  a  long  time  by  all  observers,  but  the  Nissl 
method  shows  the  changes  more  clearly  than  any  of  the  others. 

In  addition  to  these  changes  one  may  mention  the  multiplica- 
tion of  the  white  corpuscles  and  their  migration  from  the  vessels 
by  diapedesis,  as  due  in  part  perhaps  to  the  proliferation  of  cellu- 
lar elements  of  the  neuroglia  which  accumulate  in  the  interstitial 
tissue,  principally  in  the  neighborhood  of  the  vessels  or  about  the 
nerve  cells.  At  600  diameters  one  easily  distinguishes  the  small 
white  cells  (lymphocytes),  with  small  nuclei  deeply  colored  and 
with  but  a  small  amount  of  protoplasm ;  large  white  globules  with 
protoplasm  somewhat  abundant  and  with  voluminous  nuclei 
irregular  in  form  and  less  impregnated  than  those  of  the  lympho- 
cytes by  the  methylene  blue;  and,  finally,  polynuclear  leucocytes. 
But  interest  in  Nissl's  method  is  chiefly  in  the  study  of  the  lesions 
of  the  nerve  cells.  At  600  diameters  one  sees  the  profound  altera- 
tions undergone  by  these  cells.  In  examining  the  elements  of  the 
third  layer  (large  pyramidal  cells)  or  the  giant  cells  of  Betz,  there 
is  a  tendency  in  them  to  lose  their  triangular  shape  and  become 
oval  or  rounded,  the  protoplasmic  prolongations  are  atrophied  and 
but  slightly  visible,  the  chromophilic  granules  for  the  most  part 
undergo  a  process  of  disintegration  and  are  reduced  to  a  sort  of 
fine  powder  or  dust,  or  are  entirely  dissolved  in  the  mass  of  proto- 
plasm.    The  author  then   discusses  the  nature  of  the  process. 


22  G.  ALFRED  LAWRENCE. 

some  authors  (Magnan,  Mierzijewski,  Mendel)  claiming  the 
primary  disease  to  be  that  of  the  neuroglia  framework — an  inter- 
stitial encephalitis.  Others  on  the  contrary  (Tuezeck,  Ziegler, 
Binswanger,  Joffroy,  Pierret)  claim  it  affects  primarily  the 
nervous  tissue,  either  the  nerve  fibers  or  the  nerve  cells ;  thus  being 
a  parenchymatous  encephalitis.  The  .  more  Ballet  studies  the 
pathological  anatomy  of  dementia  paralytica  the  more  he  is  con- 
vinced that  the  first  and  most  important  lesions  are  those  of  the 
blood  vessels.  These  are  seen  in  every  case,  while  those  of  the  cells 
are  inconstant,  variable  in  degree,  and  subordinated  to  those  of 
the  vessels.  This  is  not  to  say  th9,t  the  cellular  alterations  may  be, 
as  some  authors  claim,  the  result  of  the  mechanical  choking  of  the 
cells  by  the  proliferating  interstitial  tissue  which  makes  their 
pathology  more  complex,  but  he  thinks  the  result  is  due  less  to  the 
compression  by  the  thickened  neuroglia  than  to  the  difficulties  of 
assimilation,  owing  to  either  the  circulatory  obstruction  or  the 
action  of  the  toxines  carried  by  the  blood.  Ballet  then  discusses 
the  relation  of  syphilis  to  dementia  paralytica,  and  states  that  the 
pathological  anatomical  findings  in  the  two  cases  are  practically 
identical,  and  advocates  a  syphilitic  etiology  for  the  disease. 

In  this  historical  review  of  the  literature  on  the  pathological 
conditions  found  in  dementia  paralytica  by  the  employment  of  the 
Nissl  method,  it  is  to  be  noted  that  but  few  of  the  contributions 
were  accompanied  by  figures  illustrating  the  various  pathological 
findings  described  in  the  text. 

Technique.  Turning  to  the  technique  employed  in  this  work, 
first  will  be  described  a  method  used  in  transporting  material  con- 
siderable distances  in  the  minimum  amount  of  space,  and  prepar- 
ing the  same  in  the  shortest  possible  time. 

On  several  occasions  the  writer  was  enabled  to  secure  more 
than  one  brain  at  th-e  same  time,  and  at  a  considerable  distance 
from  the  laboratory.  ~  It  was  desired  to  place  small  blocks  from 
various  parts  of  each  of  the  brains  in  various  fixative  media  in  the 
shortest  possible  time,  and  to  put  them  into  the  smallest  possible 
space  for  transportation.  The  smallest  size  of  tin  boxes  known  as 
"Miller's  patent  seariiless  box"  (Fig.  A)  were  secured  at  trifling 
cost  at  Eimer  &  Amend's,  in  New  York  city;  though  any  small 
box  would  answer  the  purpose.  These  measured  but  2.5  c.  c.  in 
diameter  and  1.25  c.  c.  in  depth.    One  gross  of  these  boxes  occupy 


DEMENTIA  PARALYTICA. 


23 


only  a  space  of  15  c.  c.  square  by  5  c.  c.  in  depth.  By  piercing  a 
hole  in  both  the  cover  and  bottom  of  these  boxes  a  free  circulation 
of  the  fixative  medium  is  secured — as  mentioned,  any  other  small 
box  or  phial  admitting  of  the  free  circulation  of  the  fixative  me- 
dium could  be  used ;  but  these  chanced  to  be  the  most  convenient 
and  available  receptacles  to  the  writer.  By  placing  a  bit  of  ab- 
sorbent cotton  or  cheesecloth  in  both  the  bottom  of  the  box  and  in 
the  cover  the  specimen  is  perfectly  protected.  A  square  box  of 
black  pins  (Fig.  B),  such  as  can  be  secured  at  any  drygoods 
store  at  trifling  cost,  was  purchased.  Small  squares  of  cardboard 
were  cut  out  and  numbered  in  duplicate,  using  a  lead  pencil.   Each 


Fig.  A. 

number,  with  its  single  duplicate,  was  placed  upon  a  pin  and  re- 
turned to  its  position  in  the  box.  The  various  fixative  fluids 
desired  were  carried  in  small  glass  jars  with  ground  glass  covers. 
All  these  preparations  are  made  in  advance  so  that  at  the  autopsy, 
upon  removing  the  brain,  small  pieces  can  be  taken  from  any  part 
of  the  cortex,  each  one  placed  in  a  separate  small  tin  box  with  a 
number  from  one  of  the  pifts.     The  other  or  duplicate  number  is 


24  G.  ALFRED  LAWRENCE. 

left  upon  the  pin,  and  the  latter  thrust  into  the  space  on  the  brain 
surface  from  which  the  block  was  taken  (Plate  I,  Fig.  i).  The 
small  tin  box  is  then  thrown  into  whatever  fixative  fluid  is  desired, 
and  the  fluid  entrrs  and  fills  up  the  interior  by  means  of  the  open- 
ings above  described,  the  whole  process  taking  less  time  than  re- 
quired in  explanation.     In  this  way  a  large  number  of  blocks  can 


Fig.  B. 

be  taken  from  one  or  more  brains  without  any  possibility  of  con- 
fusion, and  in  a  minimum  amount  of  time,  and  likewise  take  up  a 
minimum  amount  of  space,  requiring  no  writing  or  labeling  of 
specimens  at  the  time.  After  all  blocks  desired  are  removed  the 
brain  is  carefully  placed  upon  cotton  in  a  tin  pail  of  the  required 
size  in  whatever  fixative  fluid  is  desired,  and  other  brains  can  be 
treated  similarly. 

At  the  laboratory  subsequently  the  exact  locality  from  which 
blocks  were  taken  can  be  noted  at  leisure  in  the  most  accurate 


DEMENTIA  PARALYTICA.  25 

manner.  The  writer  has  by  this  method  taken  blocks  from  vari- 
ous parts  of  two  separate  brains,  placed  them  in  half  a  dozen 
different  fixative  fluids,  and  packed  them  up,  together  with  the 
tw^o  brams  in  tin  pails  of  suitable  diameter,  placing  everything  in 
a  hand  bag  of  medium  size,  and  carried  the  same  many  miles  on 
the  train  without  the  slightest  inconvenience  or  knowledge  by 
others  of  the  contents  ot  the  hand-bag.  The  fixative  agents  em- 
ployed in  this  work  were  alcohol  absolute,  alcohol  95  per  cent, 
formalin  10  per  cent  solution  (40  per  cent  formaldehyde,  i  part 
by  volume,  water  9  parts  by  volume).  Van  Gehuchten's  fluid 
(alcohol  absolute  (5o,  chloroform  30,  and  glacial  acetic  acid  10 
parts  by  volume),  and  Lang's  solution  (mercuric  chloride  5 
grams,  sodmm  chloride  6  grams,  acetic  acid  5  grams,  and  water 
100  grams).  The  most  satisfactory  results  have  come  from  fixa- 
tion in  Van  Gehuchten's  fluid,  and  the  alcohols.  In  the  employ- 
ment of  the  latter  more  or  less  shrinkage  results,  but  this  can  be 
recognized,  and  the  chromatic  substance  within  the  cell  is  usually 
well  marked.  Van  Gehuchten's  fluid  was  used  as  follows :  Small 
blocks,  not  more  than  .3  to  .5  c.  c.  in  thickness,  were  immersed  in 
Van  Gehuchten's  fluid  and  left  for  twelve  hours.  They  were  then 
placed  in  95  per  cent  alcohol,  where  they  remained  until  desired 
for  use.  No  changes  in  the  contour  of  the  cells  were  observed  to 
result,  and  the  chromatic  substance  in  these  cells  was  well  shown 
in  the  subsequent  staining.  Blocks  to  be  imbedded  were  then 
placed  in  absolute  alcohol,  and,  for  the  paraffin  method,  trans- 
ferred to  xylol,  and  left  in  the  latter  for  several  hours  till  thor- 
oughly permeated.  They  were  then  placed  in  paraflin — melting 
point  about  50°  C.,  for  from  45  minutes  to  one  hour,  and  then 
transferred  to  another  paraflin  bath  of  the  same  melting  point  for 
the  same  length  of  time,  so  as  to  secure  complete  penetration  and 
the  removal  of  all  xylol.  The  blocks  were  then  imbedded  and  sub- 
sequently sectioned  by  a  Minot  microtome  serially.  The  sections 
were  made  varying  in  thickness  from  2  to  15  microns,  those  from 
6  to  10  microns  being  found  best  for  study  of  the  arrangement 
and  internal  structure  of  the  cells.  The  celloidin  method  was  also 
employed,  but  it  was  more  difficult  to  secure  thin  sections  when 
desired,  and  especially  to  arrange  them  serially.  A  thin  smear  of 
tgg  albumin  was  placed  upon  a  perfectly  clean  slide,  several  con- 
secutive sections  placed  upon  the  same,  and  then  a  small  quantity 


26  G._  ALFRED  LAWRENCE. 

of  water  by  means  of  a  pipette  allowed  to  flow  under  the  sections. 
This  was  gently  warmed  upon  the  water  bath  or  over  an  alcohol 
lamp  until  the  sections  were  perfectly  flattened  out.  The  water 
was  drawn  off  and  the  sections  allowed  to  dry.  This  treatment 
permitted  all  subsequent  manipulations  with  the  sections  upon  the 
slides,  without  their  floating  off  or  becoming  disturbed  or  injured. 
The  slides  were  then  placed  in  xylol  to  dissolve  out  all  paraffin 
and  run  down  in  successive  grades  of  alcohol  from  absolute  alco- 
hol to  2P  P^r  cent  alcohol,  and  from  the  latter  immersed  in  water. 
The  sections  were  then  stained  upon  the  slide  by  means  of  an 
aqueous  solution  of  methylene  blue,  as  given  by  Nissl  (methylene 
blue,  3.75  grams;  A^enetian  soap,  1.75  grams,  and  distilled  water 
I,ooo  c.  c),  or  by  a  i  per  cent  aqueous  solution  of  methylene 
violet  or  a  i  per.  cent  aqueous  solution  of  thionin. .  A  counter 
stain  of  erythrosin  was  used  in  some  cases  after  treatment  with 
methylene  blue,  giving  the  achromatic  substance  a  pink  color  in 
contrast  to  the  blue  color  of  the  chromatic  substance.  The  routine 
method  was  to  gently  heat  the  slide  covered  with  the  stain  for  two 
minutes  over  an  alcohol  lamp,  keeping  the  slide  in  constant  mo- 
tion, and  only  allovv'ing  it  to  becorne  sufficiently  heated  so  that  the 
steam  would  come  from  the  surface,  but  no  bubbling  of  the  dye 
in  solution.  The  dye  v/as  then  gently  washed  off,  the  slide  im- 
mersed in  water,  and  then  run  up  into  30,  50,  70,  80, 
95  per  cent,  alcohol,  absolute  alcohol  plus  xylol  equal  parts, 
xylol,  and  finally  mounted  in  xylol-damar.  Some  slides  were 
placed,  after  immersion  in  water  following  the  staining 
process,  in  anilin-oil  10  parts,  absolute  alcohol  90  parts,  and 
subsequently  treated  as  described  by  Nissl,  and  finally  mounted  in 
benzene-colophonium.  The  first  method,  however,  gave  the  most 
satisfactory  results  in  the  hands  of  the  writer,  and  which,  as  seen, 
embodies  various  modifications  of  the  original  Nissl  method.  Sec- 
tions prepared  in  the  routine  method  above  described  have  been 
frequently  examined  under  the  microscope,  also  frequently  ex- 
posed to  sunlight,  and  at  times  to  the  powerful  rays  of  the  electric 
arc  in  the  photomicrographic  work,  but  were  in  nowise  faded  or 
injured  after  a  period  of  two  years  from  the  time  of  preparation. 

In  the  micrographic  work  the  most  painstaking  care  was  em- 
ployed in  every  detail  of  the  work.  Achromatic  objectives  of 
various  power  with  compensating  eye-pieces  in  different  combina- 


DEMENTIA  PARALYTICA.  27 

tions  were  used  so  as  to  produce  different  magnifications  up  to 
1,400  diameters.  Oil-immersion  lenses  were  not  used,  as  the 
above  combination  secured  the  greatest  possible  depth  under  such 
high  powers.  The  time  of  exposure  varied  from  a  few  seconds  in 
the  low  power  photomicrographs  to  five  minutes  in  some  of  those 
magnified  1,400  diameters. 

Material.      Some   twenty   brains   were   secured,    and    sections 
made  from  various  parts  of  them  all  and  studied  in  connection 
.with  this  article.     Three  brains  of  cases  electrocuted  at  Ossining, 
I  and  in  which  the  autopsy  occurred  immediately  afterwards  and 
;the  material  placed  in  various  fixative  media,  were  secured.     The 
photomicrographs  representing  the  practically  normal  brain  histo- 
logically in  the  first  part  of  this  article  were  taken  from  one  of 
[these  brains,  marked  A  (Plate  I,  Pig.  i),  a  man  thirty-six  years 
of  age  who  had  been  confined  in  Sing-Sing  State  Prison  for  over 
two  years  and  leading  the  regular  routine  prison  life  during  that 
iperiod.    The  autopsy  was  held  immediately  after  death  by  electro- 
■cution.    The  body  was  well  nourished,  and  no  pathological  condi- 
[tion  of  the  central  nervous  S3^stem  or  other  organs  was  found. 
■  Small  blocks,  .3  to  .5  c.  c.  in  thickness,  from  various  convolutions 
I  of  the  brain  were  placed  in  the  various  hardening  or  fixative 
i  agents  described  above,  and  the  brain  itself  immersed  in  95  per 
icent  alcohol.    The  blocks  were  subsequently  imbedded  in  paraffin, 
[sectioned  serially,  stained,  differentiated,  and  mounted  as  already 
•  described. 

l  '-.Brains  from  three  cases  of  dementia  paralytica  were  also  se- 
cured and  studied.  Sections  from  the  one  marked  B  (Plate  X, 
Fig.  29)  were  used  to  illustrate  this  article  in  its  pathological  por- 
tion. The  paralytic  dement  from  which  brain  B  was  taken  was  a 
lawyer,  had  a  collegiate  education,  was  single,  no  history  of  syph- 
ilis, and  family  history  negative.  Was  native  of  the  United 
States.  The  disease  began  at  about  the  age  of  twenty-eight  years 
with  the  usual  change  of  character,  followed  by  grandiose  ideas 
and  maniacal  excitement.  Asylum  treatment  for  over  a  year 
caused  his  symptoms  to  clear  up  sufffciently  so  that  he  was  dis- 
charged. For  nearly  two  years  he  was  in  a  fairly  quiet  condition. 
He  then  broke  out  in  a  long  period  of  excitement,  lasting  over  a 
year,  followed  by  terminal  dementia  lasting  for  one  and  a  half 
years  before  death,  which  latter  was  uncomplicated.     Duration  of 


ZS 


G.  ALFRED  LAWRENCE. 


the  disease  was  thus  over  five  and  a  half  years,  during  which 
period  there  was  a  remission  lasting  two  years,  in  which  he  did 
not  require  asylum  treatment.  There  was  contracture  of  both 
arms  and  legs  for  three  months  preceding  death.  Mentally  he 
was  a  little  brighter  during  that  time.  At  death  the  body  was 
immediately  placed  upon  ice,  and  the  autopsy  performed  fifteen 
hours   later.     The  body  weighed   78  pounds   at   death   and   was 


Plate  I,  Fig.  i. 

flexed.  Two  small  cavities,  each  the  size  of  a  pea,  were  found  in 
the  apex  of  the  right  lung.  The  lymphatics  were  somewhat  en- 
larged. Heart  was  atrophied.  There  was  meningeal  thickening. 
The  ependyma  in  the  posterior  part  of  the  floor  of  the  fourth  ven- 
tricle was  very  slightly  granular.  The  membranes  were  anemic, 
and  there  was  no  edema  or  fluid.  The  convolutions,  especially  in 
the  region  of  the  central  convolutions,  are  widely  separated  from 
one  another ;  but,  as  will  be  described  later,  this  is  largely  due  to 
mechanical  causes  in  subsequent  fixation.  In  addition  to  these 
brains  over  a  dozen  were  secured  from  other  sources,  mostly  from 
the  New  York   City  Morgue,   of  persons   who  had   committed 


DEMENTIA  PARALYTICA.  29 

suicide  or  died  suddenly  from  accident  or  homicide,  with  autopsy 
performed  within  a  few  hours  after  death. 

Normal  Cortex.  The  descriptions  and  plates  herein  contained, 
and  illustrating  the  normal  human  cortex,  are  not  intended  to  give 
the  ide^  of  being  in  any  way  a  complete  exposition  of  such  a  vast 
subject;  but  it  has  been  the  aim  to  give  photomicrographs  with 
accompanying  descriptions  of  typical  sections  and  cells  from  vari- 
ous regions  of  the  cortex,  as  a  basis  of  comparison  with  sections 
taken  from  corresponding  regions  of  the  cortex  in  a  case  of  de- 
mentia paralytica.  Neither  is  this  contribution  intended  to  be  in 
the  nature  of  an  atlas,  being  much  too  limited  in  scope  for  such  a 
work;  but  to  illustrate  as  far  as  practicable  the  structures  found 
in  what  can  be  considered  a  fairly  normal  brain,  with  the  condi- 
tions founa  in  a  brain  of  one  dying  from  dementia  paralytica. 
Various  regions  of  the  normal  cortex  from  brain  A,  one  of  the 
electrocuted  cases  (Plate  I,  Fig.  i),  with  its  accompanying  plates 
will  be  first  described,  and  then  will  follow  a  like  description  of 
the  corresponding  region  with  its  accompanying  illustrations  of 
the  brain  of  the  case  of  dementia  paralytica,  brain  B  (Plate  X, 
Fig.  29).  Plate  I,  Fig.  i,  above  referred  to,  shows  the  left  hemi- 
sphere of  Brain  A,  natural  size ;  a  normal  brain,  with  well  marked 
convolutions  and  sulci.  The  small  pieces  of  cardboard  with  their 
contained  figures  show  the  particular  point  from  which  the  subse- 
quent blocks  were  taken,  and  also  illustrate  the  method  of  exact 
localization  of  blocks  described  under  the  heading  of  technique. 

Frontal  Region. — Turning  now  to  the  several  cortical  re- 
gions, various  portions  of  the  first,  second  and  third  frontal 
convolutions  were  examined  in  different  brains,  and  typical  of 
this  region  is  the  section  shown  in  Plate  I,  Fig.  2,  which,  with 
minor  modifications,  is  similar  to  that  of  all  portions  of  this  re- 
gion, and  will  now  be  described  in  detail.  The  block  from  which 
this  section  was  taken  comprised  a  part  of  the  external  surface 
of  the  first,  or  superior  frontal  convolution,  including  the  entire 
width  of  the  gyrus  for  a  distance  of  .4  cm.,  and  taken  from  the 
position  shown  by  the  figure  i,  Plate  I,  Fig.  i.  The  gyrus  at  this 
point  measures  .6  cm.  in  width,  so  that  the  actual  size  of  this  sec- 
tion is  .6  cm.  in  width  by  .4  cm.  in  depth,  and  it  is  6  2-3  microns 
in  thickness. 

The  block  at  autopsy  immediately  after  death  was  placed  in 
Van  Gehuchten's  fluid,  where  it  remained  for  twelve  hours,  when 


30  G.  ALFRED  LAWRENCE. 

it  was  placed  in  alcohol  95  per  cent  until  ready  for  use.  It  was 
then  imbedded  in  paraffin,  sectioned  serially  with  a  Minot  micro- 
tome, stained  for  two  minutes  in  warm  methylene  blue,  decolor- 
ized in  alcohol,  cleared  in  xylol,  and  mounted  in  xylol-damar. 
Plate  I,  Fig.  2,  referred  to  above,  shows  the,  section  under  a 
magnification  of  14  diameters.  The  section  has  been  broken  in 
manipulation,  but  shows  the  general  striated  arrangement  of 
the  cells  radiating  outward  from  the  white  medullary  center  to 


•  Plate  I,  Fig.  2.'      ■    '■ 

the  surface ;  also  the  layering  of  the  cortex.  The  strip  of  cor- 
tex outlined  in  ink  on  the  plate  at  a  is  that  porti'  n  shown  in 
Plate  II,  Fig.  3,  under  a  magnification  of  160  diameters.  The 
outer  pale  layer,  the  thicker  cellular  layers,'  and  the  inner  med- 
ullary white  portion  can  easily  be  differentiated  even  with  this 
magnification. 

The  outer  layer  is  found  to  be  fairly  uniform  in  thickness  in 
this  section,  but  we  will  find  later  that  there  may  be  a  consider- 
able variation,  not  only  in  the  thickness  of  this  layer,  but  also' 
of  the  other  layers,  and  consequently  of  the  entire  cortex.  The 
radial  arrangement  of  the  cells  from  the  medullary  white  sub- 
stance is  especially  well  shown  under  this  magnification,  and  a 
more  general  and  comprehensive  view  of  both  the  normal  ar- 


DEMENTIA  PARALYTICA. 


31 


rangenients  and  of  derangements  and  disturbances  due  to  path- 
ological changes  can  be  made  out  under  this  magnification  than 
by  higher  powers  in  which  but  minute  areas  are  seen.  These 
latter  high  magnifications  are  of  course  also  necessary  for  the 
complete  study  of  all  the  details  of  such  variations  or  patholog- 
ical changes.    Plate'II,  Fig.  3,  magnified  100  diameters,  is  that 


it- ,-4  J.  C-  i-o  X 


portion  of  the  section  outlined  in  ink  in  Plate  I,  Fig.  2  at  a.  De-- 
colorization  has  been  carried  on  here  to  such  a  degree  as  to 
make  many  of  the  cells  appear  somewhat  pale  and  'washed  out, 
and  to  cause  a  complete  decolorization  of  many  of  the  neuroglia 
cells.  This,  however,  admits  of  a  better  study  of  the  arrange- 
ment of  the  internal  structure  of  the  cells,  as  a  too  deep  coloriza- 
tion does  not  sufficiently  differentiate  the  chromophilic  granules 
and  network.  The  outer  surface  of  the  cortex  is  here  seen  to  be 
smooth  and  regular.    Immediately  beneath  is  the  first  or  superfi- 


,32  G.  ALFRED  LAWRENCE. 

cial  layer,  pale  in  color,  .25  mm.  in  thickness,  and  characterized 
by  a  paucity  of  cells  irregularly  arranged  and  appearing  upon 
a  colorless  background,  which  we  know  from  sections  treated 
by  the  Weigert  method  to  be  made  up  of  large  numbers  of 
densely  packed  nerve  fibers  and  processes.  In  the  plate  are  seen 
for  the  most  part  neuroglia  cells,  but  under  a  high  power  here 
and  there  nerve  cells  are  found,  rounded,  spindle-shaped,  or 
polygonal  in  form,  with  a  nucleus  filling  up  almost  the  entire 
cell-body,  and  with  no  visible  dendritic  processes,  or  at  most 
but  one  or  two  extending  vertically  or  at  right  angles  to  the 
surface  of  the  cortex.  The  cell-body  contains  but  a  small  mass 
of  chromophilic  substance,  usually  forming  a  narrow  band  about 
the  nucleus  with  thickenings  where  the  dendritic  processes  are 
given  ofif.  The  cells  with  no  visible  processes  of  course  may 
have  such  extending  in  a  direction  outside  of  the  plane  of  the 
section.  Fig.  C  shows  one  of  these  cells  containing  no  visible 
processes,  with  a  rounded  cell^body,  a  large  rounded  nucleus 
almost  filling  up  the  same  and  surrounded  by  a  uniformly  thin 
band  of  chromatic  substance.  Fig.  D  shows  another  cell  from 
this  same  region  with  a  single  proces  vertical  to  the  surface  of 
the  cortex.  Here  again  the  large  rounded  nucleus  almost  fills 
up  the  cell-body  and  is  surrounded  by  a  thin  band  of  chromatic 
substance  thickened  at  the  point  where  the  dendritic  process  is 
given  off,  and  extending  into  the  same  for  a  short  distance.  Fig. 
E  shows  a  similar  cell,  but  with  two  processes  extending  in  a 
nearly  horizontal  direction.  The  thin  chromatic  band  is  here 
thickened  at  both  extremities.  The  greatest  diameter  of  the 
■  cell  in  Fig.  D  is  vertical,  while  in  Fig.  E  it  is  horizontal,  in  Fig.  C 
of  course  being  practically  uniform.  Occasionally  cells  are  seen 
with  one  process  vertical  and  the  other  horizontal,  as  in  Fig.  F, 
this  being  polygonal  in  shape.  The  nuclei  in  all  of  these  cells 
are  well  defined,  large,  and  contain  a  small  amount  of  chroma- 
tin in  the  form  of  a  poorly  differentiated  network,  and  at  some 
point  containing  a  distinct  nucleolus.  According  to  Nissl's  clas- 
sification of  nerve  cells  these  would  be  known  as  karyochrome 
nerve  cells.  The  neuroglia  cells  are  smaller,  rounded  or  oval  in 
shape,  contain  a  nucleus,  and  are  much  more  numerous  in  this 
layer  than  the  comparatively  scarce  nerve  cells.  The  second  or 
pyramidal  cell  layer,  to  simplify  the  layering  of  the  cortex  to  the 
greatest  extent,  as  previously  described,  is  made  to  include  both 
the  large  and  small  pyramidal  cells.  This  measures  in  the  plate 
(Plate  II,  Fig.  3)  1.40  mm.  in  depth.  This  layer  thus  includes 
the  large  and  small  pyramidal  cell  layers  and  the  ganglionic  cell 
layer  of  Hammarberg,  and  the  large  and  small  pyramidal  cell 
layers  of  Golgi  and  of  Cajal.  (See  Table  I.)  Hammarberg 
(1895)   in  his  description  of  this  region  states  that  the  layer  of 


DEMENTIA  PARALYTICA.  33 

small  pyramidal  cells  does  not  form  a  distinct  layer,  but  grad- 
ually passes  over  into  that  of  the  third  layer  of  large  pyramidal 
cells,  so  that  the  two  in  his  division  make  a  layer  .80  mm.  in 
depth.  He  further  states  that  the  under  border  of  the  third 
layer  is  difficult  to  determine,  so  that  there  is  no  distinct  fourth 
layer.  This  fourth  layer  is  then  described  as  containing  small 
pyramidal  cells  less  thickly  distributed  than  in  the  layer  above, 
intermingled  with  which  are  some  smaller  irregular  cells,  giving 
the  appearance  of  a  region  poor  in  cells ;  and  he  notes  further 
that  in  many  places  the  difference  is  so  slight  that  it  does  not 
make  a  separate  layer.  His  fifth  layer  is  described  as  a  .70  mm. 
thick  ganglion  cell  layer,  made  up  of  somewhat  larger  and 
more  closely  packed  pyramidal  cells.  These  layers, — second, 
third,  fourth  and  fifth  layers  of  Hammarberg,  are  all  included 
in  this  second  layer  of  the  writer,  and  in  this  section  measures 
about  1.40  mm.  in  thickness.  It  is  made  up  of  pyramidal  cells 
varying  in  size  in  all  parts  of  the  layer,  so  that  in  any  region,  ex- 
cepting a  band  below  the  middle  portion  to  be  described  later, 
pyramidal  cells  of  different  size  may  be  seen  in  close  proximity. 
As  a  rule,  however,  the  larger  pyramidal  cells  are  found  mostly 
in  the  deeper  portion  of  the  layer.  But  here  as  elsewhere  are 
to  be  seen  the  small  pyramidal  cells  interspersed.  There  are  also 
to  be  seen  some  rounded  and  irregular  cells  throughout  this 
layer.  Just  below  the  middle  of  this  second  layer  is  seen  a  belt 
some  .30  mm.  in  width,  in  which  small  pyramidal  cells  decidedly 
predominate  and  containing  but  few  larger  and  medium  sized 
pyramidal  cells.  This  region  is  comparable  to  the  fourth  layer 
of  Hammarberg,  but  as  it  contains  no  elements  differing  from 
the  region  above  and  below,  but  simply  varies  in  the  relative 
number  and  size  of  the  same,  it  does  not  seem  to  the  writer 
worthy  the  designation  of  a  separate  layer  with  the  resulting 
increase  in  the  number  of  layers.  Both  above  and  below  this 
belt  large  and  small  pyramidal  cells  are  intermingled ;  the  large 
pyramidal  cells  increasing  in  proportion  from  above  downward. 
Fig  G  (G  of  Plate  H.  Fig.  3)  shows  the  details  of  structure  of 
one  of  these  small  pyramidal  cells  under  a  high  magnification 
(x  1,300.  No.  3  ocular,  1-12  in.  oil  immersion  objective,  Leitz). 
By  focussing  in  different  planes  the  large,  broad,  apical,  den- 
dritic process  is  seen  extending  vertically  towards  the  surface  of 
the  cortex.  It  contains  chromophilic  granules  arranged .  with 
the  long  axis  parallel  to  the  axis  of  the  cell.  The  cell-body  is  in 
the  form  of  a  pyramid  with  rounded  sides.  The  large  nucleus  is 
irregularly  oval  with  the  long  axis  parallel  with  the  long  axis  of 
the  cell.  The  nucleolus  is  centrally  located  and  surrounded  by 
the  slightly  stained  nuclear  contents.  From  the  lower  portion 
of  the  cell-body  are  given  off  three  dendritic  processes,  one  of 
which  subsequently  branches  into  two  processes,  at  which  point 


34 


G.  ALFRED  LAWRENCE. 


a  mass  of  chromatin  is  seen,  one  of  the  so-called  "wedges  of 
division"  (Versweigungs-Kegln)  of  Nissl.  These  dendritic 
processes  contain  no  chromophilic  granules,  but  at  the  point 
where  they  are  given  ofif  from  the  cell-body  are  found  aggrega- 
tions of  chromophilic  granules  which  also  surround  the  nucleus 
on  either  side,  their  long  diameter  extending  in  general  parallel 
with  the  long  axis  of  the  cell.  Plate  II,  Fig.  4,  is  a  photomicro- 
graph of  this  same  cell  as  stated,  indicated  by  the  letter  G  in 
Plate  II,  Fig.  3,  and  shown  in  Fig.  G  of  the  text  as  already  de- 
scribed.   In  order  to  secure  a  focus  by  which  the  cell  processes 


Plate  II,  Fig.  4. 


could  be  seen  even  faintly  the  nucleus  and  nucleolus  are  almost 
entirely  out  of  the  plane  of  focus,  the  latter  showing  faintly  how- 
ever. Immediately  about  the  nucleolus  there  is  a  slightly  pale 
area,  a  portion  of  the  nucleus.  The  contents  of  this  cell-body 
itself  present  for  the  most  part  the  appearance  of  a  very  dark, 
almost  homogenous,  intensely  stained  chromatic  substance,  and 
gives  only  a  partial  idea  of  the  real  structure  and  arrangement 
of  the  granules  as  seen  in  Fig.  G.  The  contour  of  the  nucleus 
cannot  be  distinctly  made  out,  nor  the  relative  position  of  the 
nucleolus  in  the  same.     The  individual  chromophilic  granules 


DEMENTIA  PARALYTICA.  35 

cannot  be  distinguished  excepting  at  the  base  of  the  right  lateral 
dendritic  process.  The  apical  dendritic  process  appears  as  a 
mere  shadow,  owing  to  its  being  out  of  the  plane  of  focus.  The 
basal  dendritic  process  show  almost  as  well  as  in  Fig.  G,  except- 
ing the  branching  of  the  one  at  the  left  which  is  but  faintly  indi- 
cated. The  small  mass  of  chromatin  at  this  point — the  so-called 
"wedge  of  division,"  of  Nissl — is  also  but  faintly  indicated.  The 
general  contour  of  the  cell,  points  from  which  the  dendritic 
processes  are  given  off,  and  position  of  the  nucleolus  are  accu- 
rately represented.  Had  a  plane  been  selected  showing  the  nu- 
cleus accurately  some  of  the  processes  would  have  been  entirely 
out  of  focus.  Other  cells  adjacent  to  the  one  just  described  are 
seen  to  be  less  deeply  stained  and  the  chromatin  is  seen  in  the 
form  of  larger  and  smaller  indistinctly  rounded  or  elongated 
granules.  It  will  thus  be  seen  that  there  are  hmitations,  and 
serious  Hmitations  too,  in  the  use  of  photomicrographs,  es- 
pecially under  high  powers,  in  such  a  study  as  this.  It  would 
require  several  photomicrographs  at  various  planes  to  bring  out 
all  the  details  shown  in  the  single  Fig.  G,  which  of  course  is  a 
composite  taken  by  focussing  in  all  planes  under  a  magnification 
of  1,300  diameters,  and  showing  certain,  but  not  all,  details  of 
the  different  planes.  Of  course  outlines  are  not  so'  distinct  in 
the  real  cell  as  must  necessarily  be  made  to  appear  in  a  drawing, 
and  this  latter  might  be  compared  to  a  dissection  in  which  cer- 
tain parts  are  brought  out  prominently  at  the  expense  of  the 
normal  appearance  of  the  whole  in  life.  No  one  would  hesitate 
to  say,  however,  that  Fig,  G  gave  a  much  better  idea  though  not 
an  exact  representation  of  the  cell,  than  Plate  II,  Fig.  4,  and 
that  drawings  are  essential  accompaniments  of  such  plates  in 
the  full  elucidation  of  a  subject  of  this  kind.  These  cells  are 
known  as  stichocrome  nerve  cells  of  the  somatochrome  class. 
Fig.  H  shows  one  of  the  large  pyramidal  cells  (the  largest  to  be 
seen  in  the  plate)  under  the  same  magnification  as  in  Fig.  G 
(x  1,300.  No.  3  ocular,  1-12  in.  oil  immersion  objective,  Leitz). 
The  internal  structure  of  the  large  pyramidal  cells  is  found  to  be 
made  up  of  distinctly  stained  chromophilic  substance  in  larger 
and  smaller  irregular  granules,  some  so  fine  and  closely  ar- 
ranged as  to  completely  fill  up  the  cell-body,  thus  presenting  a 
uniform  field  of  closely  packed  minute  granules  without  any  spe- 
cial relation  to  one  another.  In  other  cells  the  granules  are 
coarser  and  present  a  somewhat  parallel  arrangement  about  the 
nulceus  and  extending  up  into  the  main  apical  process  for  some 
distance  and  also  into  the  basal  lateral  processes  in  the  same 
general  parallel  manner.  In  other  pyramidal  cells  there  is  a 
fine  chromophilic  network  with  larger  and  smaller  aggregations 
of  chromatin  as  nodes  or  enlargements  of  the  network.  In  this 
figure  the  cell-body  is  pyramidal  in  shape  with  rounded  contour 


36 


G.  ALFRED  LAWRENCE. 


merging  above  into  the  large  apical  dendritic  process,  which  is 
finally  lost  to  view  as  it  enters  another  plane.  Below  at  the 
base,  both  to  the  right  and  left,  are  given  off  several  dendritic 
processes,  some  of  which  are  seen  to  branch  a  short  distance 
from  the  cell-body.  The  large,  slightly  oval  nucleus  is  centrally 
situated  somewhat  nearer  the  base  of  the  cell  than  the  apex, 
and  contains  a  large,  eccentrically  placed  nucleolus,  surrounded 
by  the  pale,  slightly  strained,  for  the  most  part  homogenous, 


Plate  II,  Fig.  5. 

nuclear  protoplasm.  Within  the  cell-body  about  the  nucleus 
and  extending  into  the  apical  process,  and  to  a  less  extent  into 
the  basal  dendritic  processes,  are  chromophilic  granules  of 
rounded  or  elongated  shape,  and  having  a  tendency  to  be  ar- 
ranged in  groups  in  places.  Especially  at  the  point  where  a  den- 
dritic process  is  given  off  is  frequency  to  be  found  a  mass  of 
these  granules.     Often  a  wedge  or  cap  of  chromophiHc  sub- 


DEMENTIA  PARALYTICA.  37 

Stance  is  seen  at  the  point  where  a  dendritic  process  is  to  be 
given  off,  as  at  a,  or  where  a  process  divides  into  two  branches, 
as  at  h,  the  latter  being  one  of  the  so-called  "wedges  of  division" 
of  Nissl.  The  granules  vary  in  size  and  shape  and  are  arranged 
in  general  in  a  direction  parallel  to  the  long  axis  of  the  cell- 
body  and  of  the  long  axis  of  the  dendritic  process  when  extend- 
ing into  the  same.  About  the  nucleus  they  are  often  arranged 
parallel  to  its  wall.  Five  dendritic  processes  are  given  off  from 
the  base  of  this  cell,  three  of  which  are  seen  to  divide  into  two 
branches  each;  at  h,  showing  one  of  the  so-called  "wedges  of 
division"  of  Nissl,  referred  to  above.  Plate  II,  Fig.  5  is  a  pho- 
tomicrograph of  this  same  cell  indicated  by  the  figure  H  in 
Plate  II,  Fig.  3,  and  already  described  and  shown  in  Fig.  H; 
here  under  a  magnification  of  1,400  diameters.  The  body  of 
another  somewhat  smaller  pyramidal  cell  is  seen  just  behind 
the  apical  dendritic  process  of  this  cell  and  part  of  it  almost  in 
the  same  place,  so  that  it  is  difficult  to  differentiate  the  two.  It 
will  be  seen  that  the  nucleus  and  nucleolus  are  in  good  focus, 
but  that  the  basal  dendritic  processes,  excepting  at  their  origin 
from  the  cell-body,  can  scarcely  be  distinguished.  The  shape  of 
the  nucleus,  size  and  position  of  the  nucleolus,  and  arrangement 
of  the  chromatin  within  the  same  is  as  well  shown  as  in  the 
figure.  Also  the  shape  and  contour  of  the  cell-body.  The  den- 
dritic processes,  however,  as  mentioned  above,  are  out  of  the 
plane  of  focus,  so  that  only  a  very  hazy,  indefinite  indication 
of  the  beginning  of  three  of  them  can  be  made  out.  The  large 
one  at  the  left  can  scarcely  be  determined  at  all.  The  more 
central  one  at  the  left  is  faintly  outlined,  and  at  the  point  of  bi- 
furcation the  so-called  "wedge  of  division"  of  Nissl  (B)  is  seen, 
but  the  division  itself  cannot  be  determined.  Of  the  three  pro- 
cesses given  off  from  the  base  at  the  right  the  beginning  of  the 
one  most  centrally  located  can  be  very  faintly  seen  and  a  faint/ 
outline  of  the  other  two,  appearing  as  one  in  the  photomicro- 
graph is  seen.  The  apical  dendritic  process  is  so  merged  with 
the  body  of  the  cell  just  below  it  that  it  is  difficult  to  determine 
its  outline.  The  cell  protoplasm  is  more  differentiated  however 
than  in  the  preceding  plate  (Plate  II,  Fig.  4).  Here  chromophi- 
lic  bodies  are  seen  at  the  base  on  the  right  where  the  dendritic 
processes  are  given  off,  indicated  by  A  both  here  and  in  Fig.  H. 
Chromophilic  granules  are  also  seen  fairly  well  indicated  to 
the  right  and  above  the  nucleus,  in  larger  and  smaller  bodies 
without  sharp  outlines,  which  is  the  condition  actually  found  in 
the  cell.  They  are  not  sharply  and  definitely  outlined  as  shown 
in  Fig.  H,  which  in  that  respect  is  not  accurate,  but  merely 
diagrammatic.  At  the  left  and  below  the  nucleus  in  the  basal  por- 
tion of  the  cell-body  these  chromophilic  bodies  are  so  closely 


38  G.  ALFRED  LAWRENCE. 

aggregated  as  to  give  almost  a  homogenous  dark  appearance 
to  that  portion  of  the  cell,  and  it  is  only  by  carefully  focussing 
in  various  planes  that  the  chromophilic  bodies  are  made  out. 
Here  again  the  photomicrograph  without  the  accompanying 
drawing  would  give  one  only  a  partial  knowledge  of  the  struc- 
ture of  this  cell.  Cells  of  this  type  are  to  be  classified  as  large 
stichochrome  nerve  cells  of  the  somatochrome  class.  Inter- 
spersed among  these  larger  and  smaller  pyramidal  cells  in  this 
layer  are  some  small  irregular  and  rounded  cells  consisting  of 
a  large  nucleus  containing  a  nucleolus,  and  surrounded  by  a  cell- 
body  containing  in  the  smaller  cells  a  very  narrow  rim  of 
finely  granular  chromophilic  substance,  in  some  places  so  nar- 
row as  to  be  scarcely  discernible.  In  other  cells  the  cell-body 
is  much  more  developed  surrounding  the  nucleus  and  giving  off 
several  protoplasmic  processes  which  go  out  in  various  direc- 
tions. Neuroglia  cells  similar  to  those  of  the  first  layer  are 
found  interspersed  among  the  nerve  cells  in  all  parts  of  the  sec- 
tion. Small  portions  of  capillary  blood  vessels  are  shown  as  at 
I  in  the  plate  (Plate  II,  Fig.  3,  I)  where  the  vessel  is  seen  to  di- 
vide into  two  branches  below,  and  also  at  2  (Plate  II,  Fig.  3,  2), 
showing  a  single  small  capillary  extending  only  for  a  short  dis- 
tance in  this  plane.  The  walls  are  seen  to  be  exceedingly  thin, 
made  up  of  a  single  layer  of  nucleated  cells,  and  containing  red 
blood  corpuscles.  The  walls  of  these  blood  vessels  stand  in 
marked  contrast  to  the  thickened  and  tortuous  walled  vessels 
found  in  the  cases  of  dementia  paralytica  later  to  be  described. 
Below  this  is  the  third,  or  spindle  cell  layer  about  1.20  mm.  in 
thickness  in  this  section.  The  spindle  cells  in  this  layer  con- 
tain a  large  nucleus,  with  a  distinct  nucleolus,  but  no  nuclear 
net  work  could  be  made  out.  The  nuclei  in  many  of  them  pre- 
sent the  appearance  of  being  too  large  for  the  cell-body,  so  that 
often,  as  in  Fig.  I,  the  cell-body  seems  to  be  bulged  out  on  one 
side  to  accommodate  the  large  nucleus,  giving  an  eccentric 
form,  and  resulting  in  a  spindle  with  one  side  very  promi- 
nent and  the  opposite  side  quite  flattened.  The  chromatic  sub- 
stance is  arranged  in  no  definite  network  and  contains  no  dis- 
tinct chromophilic  bodies,  but  consists  of  minute  particles  close- 
ly aggregated  about  the  nucleus,  especially  at  each  pole  and 
found  in  a  lesser  amount  and  in  variable  quantities  in  the  re- 
mainder of  the  cell-body.  In  Fig.  J  the  nucleus  is  situated  ec- 
centrically at  one  end  of  the  cell-body,  so  that  most  of  the  other 
cell  contents  are  at  the  opposite  end  with  a  narrow  band  of 
closely  aggregated  chromophilic  substance  surrounding  the  nu- 
cleus at  both  ends.  The  nucleus  in  this  cell  is  more  elongated 
and  oval  in  shape,  with  distinct  nucleolus  and  otherwise  pale, 
slightly  stained  contents.     Other  cells  as  Fig.  K  are  more  or 


DEMENTIA  PARALYTICA.  39 

less  irregular  in  shape,  in  this  case  having  the  form  of  an  irreg- 
ular inverted  pyramid  containing  a  large  rounded  nucleus  near 
the  base  which  is  surrounded  by  a  narrow  band  of  dense  chro- 
matic substance.  About  this  is  an  irregular  chromatic  network 
containing  nodal  thickenings  at  some  points.  The  nucleus  con- 
tains a  distinct  nucleolus,  but  otherwise  pale  and  but  slightly 
stained  contents.  A  large  dendritic  process  is  seen  given  ofif 
below  and  two  dendritic  process  go  off  from  the  base  and  to  one 
side.  Fig.  L  shows  another  irregular  shaped  cell  with  a  den- 
dritic process  given  off  from  one  side  in  addition  to  those  from 


MMMM 

w 

.-;<:-J^: 

HHi 

r 

■■•■*^::::i 

\ 

■  i 

J 

;^. 

i  '---<? 

1 

;3b.,-^ -„_-... 

i 

•«£*■ 

* . 

^-— 

^ 

*   '*                                                1p 

Plate  III,  Fig.  6. 

each  end.  The  large  oval  nucleus  with  distinct  nucleolus  and 
otherwise  pale  contents  is  centrally  placed.  Considerable  chro- 
matic substance  is  seen  in  the  larger  cell-body  with  distinct 
granules,  forming  an  indistinct  network  at  the  point  w^here  the 
lateral  dendritic  process  is  given  off,  on  the  opposite  side  and 
also  in  the  cell-body  and  at  the  base  of  each  of  the  vertical  pro- 
cesses. Plate  III,  Fig.  6,  is  a  photomicrograph,  at  a  magnifi- 
cation of  1,400  diameters,  of  a  group  of  the  spindle  and  irregu- 
lar cells  indicated  by  the  letter  1  in  Plate  II,  Fig.  3. 

As  will  be  noted,  almost  all  the  forms  shown  in  the  above 
described  figures  are  to  be  seen  here.-    The  cell  lettered  I,  is 


40  G.  ALFRED  LAWRENCE. 

similar  in  shape  and  structure  to  that  of  Fig.  I,  including  the 
bulging  out  of  the  nucleus  to  one  side,  and  showing  an  aggre- 
gation of  chromatic  substance  in  the  form  of  a  nuclear  cap  at 
both  poles  of  the  nucleus.  An  irregular  network  of  chromatin 
is  seen  within  the  nucleus  surrounding  the  nucleolus.  But  little 
chromatic  substance,  in  addition  to  the  two  nuclear  caps  above 
described,  is  to  be  seen  in  the  small  cell-body.  Ag'ain  the  cell 
indicated  by  the  letter  J  is  very  similar  to  that  seen  in  Fig.  J, 
the  nucleus  being  at  one  end  of  the  cell-body  near  the  base  of 
that  polar  dendrite.  The  nucleolus  is  situated  at  the  lower  por- 
tion and  to  the  left  in  the  nucleus  and  with  but  little  faintly 
stained  chromatic  substance  surrounding  it.  About  the  nucleus 
in  the  cell-body  and  extending  into  both  dendritic  processes  is 
to  be  seen  considerable  chromatic  substance  arranged  in  an 
indefinite  network.  The  cell  lettered  K  is  irregularly  pyramidal 
in  shape,  approximating  to  that  seen  in  Fig.  K.  The  nucleus 
is  very  large  and  almost  entirely  fills  up  the  cell-body.  The 
nucleolus  has  the  appearance  of  being  without  the  nucleus,  but 
is  within  the  same  adjacent  to  the  wall  at  this  point.  A  small 
amount  of  chromatin  is  seen  in  the  lower  part  of  the  nucleus, 
otherwise  it  is  for  the  most  part  pale.  A  process  is  seen  given 
ofif  above  as  the  apical  dendrite  at  the  base  of  which  are  some 
few  chromophilic  granules. 

Two  basal  dendritic  processes  are  given  off,  one  to  the  right 
and  projecting  almost  vertically  downward,  and  the  other  to 
the  left  and  almost  horizontal  in  direction.  At  the  base  of  these 
processes,  especially  the  one  to  the  left,  are  seen  well  marked 
chromophilic  granules.  Otherwise  the  cell-body  is  practically 
entirely  taken  up  by  the  nucleus.  The  cell  indicated  by  the  let- 
ter L  is  somewhat  similar  to  that  of  Fig.  L  in  regard  to  having 
two  polar  dendritic  processes,  one  of  which  coming  off  laterally 
here  on  the  left  side  and  only  faintly  indicated,  being  in  a  lower 
plane.  The  nucleus  here  also  is  seen  to  occupy  the  greater  por- 
tion of  the  cell-body,  the  nucleolus  being  crowded  over  almost 
to  the  edge  of  the  same.  The  nucleus  contains  only  a  slight 
amount  of  chromatic  substance  in  its  upper  portion.  Nuclear 
caps  are  seen  above  and  below  the  nucleus  in  the  cell-body,  the 
one  above  being  the  larger,  and  surrounded  by  some  small 
chromophilic  bodies  extending  up  into  the  dendritic  process.  A 
very  slight  amount  of  very  palely  colored  chromatic  substance  is 
seen  below  the  nuclear  cap  in  the  lower  dendritic  process.  The 
lateral  dendrite  when  seen  in  focus  is  found  to  contain  a  slight 
amount  of  chromatic  substance  more  abundant  at  the  base.  The 
cell  lettered  M  is  regularly  spindle  in  shape  with  two  polar  den- 
dritic processes,  the  lower  one  not  in  the  plane  of  focus,  and 
the  upper  one  only  partially  so,  and  there  are  no  lateral  pro- 


DEMENTIA  PARALYTICA.  4 1 

cesses.  The  nucleus  is  not  in  distinct  focus,  so  that  its  outline 
is  indistinct.  The  nucleolus  is  seen  at  the  lower  part  of  the  nu- 
cleus, and  to  the  left  side  surrounded  by  a  rather  pale  indefinite 
chromatic  network.  Below  this  is  seen  some  dense  chromatic 
substance  in  the  form  of  a  nuclear  cap.  The  nucleus  really  oc- 
cupies almost  the  entire  body  of  this  cell  extending  from  the 
dark  mass  below  which  has  the  form  of  an  irregular  nuclear  cap, 
to  the  base  of  the  upper  dendritic  process  where  there  is  a 
smaller  nuclear  cap  of  chromatic  substance.  A  small  amount 
of  protoplasm  above  and  below  the  nucleus  in  the  cell-body 
extends  for  a  short  distance  into  the  dendritic  process  from 
these  nuclear  caps.  The  other  cells  seen  in  this  plate  are  sim- 
ilar in  appearance  and  structure  to  those  already  described. 
Several  neuroglia  cells  as  at  N,  rounded  or  oval  in  shape, 
are  to  be  seen  here  also  interspersed  among  the  nerve  cells, 
and  they  increase  in  number  proportionate  to  the  nerve  cell  de- 
crease as  the  white  medullary  center  is  reached.  Several  capillary 
blood  vessels  are  to  be  seen  in  this  layer,  cut  in  different  planes. 
Their  walls  are  made  up  of  a  single  layer  of  thin  nucleated  cells 
and  the  vessels  filled  with  red  blood  corpuscles.  The  cells  of 
this  layer  belong  to  the  somatochrome  class  and  either  the 
archyochrome  or  gryochrome  group,  depending  on  whether  one 
regards  the  chromatic  substance  as  making  up  a  distinct  net- 
work as  in  the  archyochrome  group  or  as  small  granules  ar- 
ranged in  threads  or  heaps  as  in  the  gryochrome  group.  It  is 
difficult  to  determine  a  network  of  any  distinctness  in  the  ma- 
jority of  these  cells,  and  they  seem  to  the  writer  to  belong 
more  to  the  gryochrome  group.  The  entire  cortex  thus  meas- 
ures in  this  section  approximately  2.85  mm.  in  thickness  as  it 
is  really  an  arbitrary  division  to  state  just  where  the  gray  cor- 
tex ends  and  the  subcortical  white  medullary  substance  be- 
gins, there  being  a  gradual  transition  from  the  one  to  other  here 
as  well  as  between  the  layers  of  the  cortex.  In  order  to  ob- 
tain the  approximate  number  and  ratio  of  the  nerve  cells  to  the 
neuroglia  cells  an  effort  was  made  to  count  the  same  in  various 
sections  of  the  photomicrograph,  counting  the  nerve  cells 
first  and  marking  each  one  as  counted  by  black  ink,  and  after- 
wards doing  the  same  for  the  neuroglia  cells.  Upon  subse- 
quently using  a  Zeiss  ocular  micrometer  divided  into  millimeter 
squares  in  a  No.  3  ocular  with  a  No.  6  objective,  thus  giving  a 
magnification  of  390  diameters,  it  was  found  that  the  former 
method,  in  which  only  a  magnification  of  100  diameters  was 
used  did  not  show  all  the  structures  present,  and  those  shown 
were  not  sufficiently  distinct  at  times  to  determine  accurately 
their  real  nature,  whether  neuroglia  cells,  portions  of  nerve 
cells,  etc.    With  the  above  magnification, — 390  diameters, — and 


42  G.  ALFRED  LAWRENCE. 

upon  focussing  in  various  planes,  it  was  found  for  instance  that 
a  single  mass  upon  the  photomicrograph  could  be  resolved  into 
two  or  more  neuroglia  cells  close  to  one  another  and  in  slightly 
different  planes.  By  using  the  above  combination  it  was  found 
that  one  side  of  the  millimeter  square  in  the  eye-piece  corre- 
sponded to  .033  mm.  of  the  stage  micrometer  and  thus  of  the 
surface  of  the  section  under  observation,  so  that  a  square  milli- 
meter of  the  ocular  network  was  therefore  equivalent  to  .03323, 
or  .00999  square  millimeters  (practically  .01  square  millimeters, 
which  latter  decimal  was  used  for  convenience  in  this  work)  of 
surface  of  the  section  under  examination.  The  ocular  microm- 
eter was  divided  into  36  squares  and  the  number  of  nerve  cells 
in  each  of  these  squares  was  counted  and  recorded  in  seven  dif- 
ferent fields,  in  this  case  in  different  parts  of  the  section,  thus 
making  252  squares  in  all.  The  result  was  added  up  and  di- 
vided by  252  in  order  to  give  the  average  number  of  nerve  cells 
for  each  square.  This  number  was  equivalent  to  that  contained 
in  .01  sq.  mm.  of  actual  surface  of  the  section,  or  practically 
i-ioo  of  a  square  mm.  The  total  number  of  neuroglia  cells  in 
108  squares  from  three  different  fields  was  determined  in  the 
same  manner,  the  resulting  total  being  divided  by  108  to  give 
the  average  number  of  neuroglia  cells  for  each  sq.  mm.  of  the 
ocular  net-micrometer  or  .01  sq.  mm.  of  actual  surface  of  the 
section.  These  results  multiplied  by  100  thus  will  give  the  num- 
ber of  nerve  and  neuroglia  cells  for  each  square  millimeter  of 
actual  surface  of  the  section.  With  this  method  the  average 
number  of  nerve  cells  to  each  sq.  mm.  of  the  ocular  net-microm- 
eter was  found  to  be  1.1685;  multiplied  by  100  gives  116.85  ^^ 
the  average  number  of  nerve  cells  to  be  found  in  each  sq.  mm. 
of  this  section  in  the  second  and  third  layers.  In  the  region  just 
below  the  middle  of  the  second  layer  previously  described  as 
made  up  almost  exclusively  of  small  pyramidal  cells  these  lat- 
ter are  found  very  densely  packed  together,  in  many  parts  as 
many  as  2."/  cells  were  found  to  each  square  on  an  average. 
This  result  multiplied  by  100  as  before  gives  the  high  average 
of  270  nerve  cells  to  each  square  millimeter  in  this  narrow  re- 
gion, whereas  the  general  average  for  the  entire  second  and 
third  layer,  not  including  this  region,  is  but  93  nerve  cells  to  the 
sq.  mm.,  thus  showing  the  great  variation  in  regions  of  the 
same  section  closely  approximating  one  another.  The  nerve 
cells  of  the  first  layer  were  so  few  and  scattered  that  they  were 
not  included  in  this  count.  In  the  same  way  the  average  num- 
ber of  neuroglia  cells  to  the  square  millimeter  of  surface  of  the 
section  was  found  to  be  125.  Counts  were  also  made  from  a 
section  from  the  first  frontal  convolution,  somewhat  anterior  to 
that  from  which  Plate  II,  Fig.  3,  was  taken.     This  latter  block 


DEMENTIA  PARALYTICA.  43 

was  hardened  in  alcohol,  the  section  was  lo  microns  in  thick- 
ness, and  similarly  stained  with  methylene  blue.  Decolorization 
was  not  carried  on  to  such  an  extent,  so  that  the  neuroglia  cells 
were  not  decolorized,  and  the  section  being  lo  microns  in  thick- 
ness in  comparison  to  6  2-3  microns  in  Plate  II,  Fig.  3,  the  neu- 
roglia cells  were  found  to  be  more  numerous.  This  would 
seem  to  indicate  that  fixing  in  Van  Gehuchteivs  fluid  and  stain- 
ing the  same  length  of  time  in  warm  methylene  blue  results  in 
a  somewhat  greater  decolorization  of  the  neuroglia  cells  in  the 
following  differentiation  than  in  sections  hardened  in  alcohol 
and  treated  similarly  in  respect  to  staining  and  dififerentiation. 
As  stated  this  section  was  10  microns  in  thickness,  whereas  that 
of  Plate  II,  Fig.  3  is  but  6  2-3  microns  in  thickness ;  but  it  will 
be  seen  by  the  following  figures  that  whereas  there  is  only  a 
slightly  greater  number  of  nerve  cells  in  the  former  as  compared 
to  the  latter  the  neuroglia  cells  are  considerably  in  excess  in  the 
former.  Here  counts  were  made  in  seven  different  fields  of  36 
squares  each  in  various  parts  of  the  second  and  third  layers  for 
the  nerve  cells,  and  in  all  three  layers  for  the  neuroglia  cells. 
The  average  number  of  nerve  cells  was  found  to  be  1.27  to  each 
sq.  mm.  of  the  ocular  net-micrometer,  Avhich  multiplied  by  100 
gives  127  as  the  average  number  of  nerve  cells  to  the  sq.  mm.  of 
surface  of  the  section.  In  the  same  way  the  average  number  of 
neuroglia  cells  was  found  to  be  1.64  to  the  square  millimeter  of 
the  ocular  net-micrometer,  which  again  multiplied  by  100  gives 
164,  as  the  average  number  of  neuroglia  cells  to  each  sq.  mm.  of 
surface  of  the  section.  The  difference  in  the  number  of  nerve 
cells  in  the  two  sections  is  not  very  great, — about  10  per  cent, 
but  in  the  number  of  neuroglia  cells  it  is  much  more  marked, — 
over  30  per  cent,  due  partly  to  the  difference  in  thickness  and 
partly  to  the  greater  decolorization  of  the  first  section  described 
(Table  II).  Hammarberg  (1895)  for  counting  nerve  cells,  and 
Popoff  (1894)  for  determining  the  ratio  of  increase  in  neuroglia 
cells  in  acute  and  chronic  cases  of  Asiatic  cholera,  used  the 
ocular  net-micrometer  in  a  manner  similar  to  that  made  use  of 
in  this  article,  but  in  each  case  in  a  different  line  of  investiga- 
tion ;  the  former  in  the  study  of  idiocy,  and  the  latter,  as  already 
stated,  in  Asiatic  cholera.  The  number  of  nerve  cells  and  of 
neuroglia  cells,  as  well  as  their  ratio  to  one  another,  varies  in 
the  different  layers  of  the  cortex.  In  the  first  layer  there  are 
but  few  nerve  cells,  whereas  the  nuroglia  cells  are  about  the 
same  or  even  more  in  number  than  in  the  other  layers,  thus 
making  a  high  ratio.  In  the  second  and  third  layers,  however, 
the  cells  are  the  important  elements  and  occupy  the  greatest 
amount  of  space,  and  although  fewer  numerically  than  the  neu- 
loglia  cells  the  latter  are  much  smaller,  less  conspicuous,  and 


44 


G.  ALFRED  LAWRENCE. 


the  ratio  is  not  so  great.  Then  again  the  cells  are  not  evenly  dis- 
tributed, but  have  a  tendency  to  be  arranged  more  or  less  in 
irregular  groups,  so  that  in  some  places  they  are  relatively 
widely  scattered,  whereas  in  others  they  are  more  closely  ag- 
gregated, so  that  a  number  of  counts  in  various  parts  of  the 
field  are  necessary  to  get  an  approximate  average  of  the  num- 
ber of  cells.  The  thickness  of  the  section,  degree  of  staining, 
and   extent   of  dififerentiation   or   decolorization   must   also   be 


Plate  III,  Fig.  7. 


considered  in  Nissl  work,  as  too  great  decolorization  will  pre- 
vent some  cells  from  being  recorded  in  a  photomicrograph,  and 
an  extremely  thin  section  would  not  contain  as  many  cells  as  a 
thicker  one.  Sections  6  2-3  and  10  microns  in  thickness  (two 
and  three  clicks  of  the  Minot  microtome)  were  used  in  this 
work,  and  when  well  stained  and  decolorization  is  not  carried 
too  far,  will  show  all  cells  to  be  found  in  such  a  plane. 

Central  Region      Turning  now  to  the  region  posterior  to  this 
we  come  to  the  motor  region  of  the  cortex,  comprising  the  an- 


DEMENTIA  PARALYTICA.  45 

terior  and  posterior  central  convolutions.  This  region  is  of 
especial  interest  in  many  ways,  and  has  probably  been  more 
extensively  studied  than  any  other  of  the  various  regions  of  the 
cortex.  Plate  III,  Fig.  7,  is  a  photomicrograph  magnified  14 
diameters,  taken  from  a  section  10  microns  in  thickness  at  the 
upper  third  of  the  anterior  central  convolution  of  Brain  A. 
(Plate  I,  Fig.  i,  2.)  This  block  was  also  fixed  in  Van  Gehuch- 
ten's  fluid,  imbedded  in  paraffin  and  sectioned  serially  by  a 
Minot  microtome.  This  section  was  then  stained  with  warm 
methylene  violet,  differentiated  in  alcohols,  30,  50,  70  and  95 
per  cent.,  and  absolute,  cleared  in  xylol  and  mounted  in  xylol- 
damar.  The  actual  size  of  the  section  which  includes  the  entire 
width  of  the  gyrus,  is  .7  of  a  c.  m.  in  width  by  .7  c.  m.  in  depth, 
and  taken  from  a  block  .4  cm.  in  thickness,  the  plane  of  the  sec- 
tion being  at  right  angles  to  the  direction  of  the  gyrus.  At  the 
point  a  and  outlined  in  ink  is  the  strip  seen  in  Plate  III,  Fig. 
8,  at  a  magnification  of  100  diameters.  The  outer  layer  of  the 
cortex  is  seen  to  be  fairly  uniform  in  thickness,  with  the  excep- 
tion of  the  regions  indicated  at  h  and  c.  At  b  this  layer  is  con- 
siderably thicker  than  in  any  other  part,  gradually  diminishing 
in  thickness  near  a  where  it  is  of  the  average  thickness.  At  the 
point  c  is  seen  a  slight  thinning  of  the  cortex,  which  in  Plate 
IV,  Fig.  9,  results  in  the  entire  disappearance  of  this  layer  and 
is  intermediate  in  degree  in  Plate  IV,  Fig.  11.  This  condition 
will  be  more  fully  discussed  in  the  description  of  these  latter 
plates,  and  it  will  be  simply  stated  now  that  this  is  an  artefact 
probably  due  to  manipulation.  The  general  radiating  appear- 
ance of  the  cortex  from  the  white  medullary  center  to  the  per- 
iphery is  well  seen  here.  In  the  region  of  the  lower  part  of  the 
second  or  middle  cortical  layer  even  with  this  low  magnification 
can  be  distinctly  seen  the  giant  pyramidal,  or  Betz  cells  ar- 
ranged singly  or  in  groups.  Below  this  the  cortex  becomes 
paler  and  finally  merges  into  the  central  medidlated  white  sub- 
stance. This  magnification  is  especially  good  for  studying  the 
arrangement  of  the  Betz  cells.  Beginning  with  the  first  group 
in  the  lowest  part  of  the  section  on  the  right,  which  is  the 
posterior  surface  of  the  gyrus,  opposite  I  is  a  single  Betz  cell 
of  moderate  size;  just  above  this,  opposite  2  is  a  group  of  two 
Betz  cells,  one  nearer  the  surface  and  above  the  other  in  the 
lower  part  of  the  second  or  pyramidal  cell  layer.  Somewhat 
higher  up,  opposite  3,  and  somewhat  deeper,  are  seen  two  very 
large  Betz  cells,  one  deeper  and  further  from  the  surface,  as 
well  as  higher  up  than  the  other.  Opposite  4  are  three  Betz 
cells  too  far  separated  to  be  considered  as  a  single  group,  so 
must  be  regarded  as  solitary  cells.  Just  above  them  at  5  are 
three  smaller  cells,  one  above  the  other  at  about  the  same  depth 
of  the  cortex.    Opposite  6  are  two  small  Betz  cells,  one  nearer 


46  G.  ALFRED  LAWRENCE. 

the  surface  than  the  other.  Then  for  a  considerable  distance 
no  Betz  cells  are  to  be  seen  until  we  reach  a  point  opposite  7 
where  a  fair  sized  solitary  cell  is  made  out.  Just  above  this 
opposite  8  are  two  rather  small  Betz  cells,  and  a  short  distance 
above  at  9  a  group  of  three  containing  two  large  and  one  small 
Betz  cell.  Opposite  10,  and  just  below  the  lower  ink  mark  are 
two  very  large  Betz  cells,  one  overlapping  t-he  other,  giving  the 
appearance  of  one  in  the  plate.  Just  above  the  ink  line  opposite 
II  is  to  be  seen  a  group  of  four  Betz  cells,  one  large,  and  the 
other  three  smaller.  These  and  those  above  and  included  be- 
tween the  two  parallel  ink  lines  can  be  seen  at  a  magnification 
of  100  diameters  in  Plate  III,  Fig.  8,  this  group  being  on  the 
extreme  right  of  the  latter.  Opposite  12  is  a  group  of  four  Betz 
cells  arranged  radially,  the  upper  of  the  two  in  the  middle  being 
the  largest,  and  the  lowest  next  in  size.  Opposite  13  is  a  large 
solitary  Betz  cell,  and  above  this  and  opposite  14  is  a  group 
of  three  Betz  cells.  Opposite  15  is  another  large  solitary  Betz 
cell,  below  which,  and  a  little  deeper  in  the  cortex  between  it 
and  the  previously  described  group,  is  another  Betz  cell  of  me- 
dium size.  Just  above  this  is  a  group  of  two  smaller  Betz  cells. 
Opposite  16  are  three  large  cells  in  a  group  which  are  just  to 
the  left  of  Plate  III,  Fig.  8,  and  are  intermediate  in  type  be- 
tween the  well  defined  Betz  cells  and  the  ordinary  large  pyram- 
idal cells,  above  this  and  opposite  17  is  another  group  of  four 
cells  similar  in  type.  Opposite  18  is  a  group  of  two  Betz  cells, 
one  considerably  larger  than  the  other  and  nearer  the  surface 
of  the  cortex ;  in  the  same  radial  line  is  a  medium  sized  solitary 
Betz  cell.  Just  above  this  are  five  Betz  cells  opposite  19  and 
radially  arranged  in  a  row.  Opposite  20  is  a  solitary  Betz  cell, 
and  just  above  opposite  21  is  a  group  of  two  Betz  cells,  one  very 
large  and  the  other  quite  small.  Above  this  (to  the  left)  are  a 
number  of  pyramidal  cells  scarcely  large  enough  to  be  consid- 
ered as  Betz  cells,  although  as  previously  noted  there  are  inter- 
mediate forms  which  might  be  considered  as  very  small  Betz 
cells  or  very  large  pyramidal  cells.  Opposite  22  are  seen  three 
Betz  cells  rather  scattered,  the  one  in  the  middle  being  at  a 
deeper  level  of  the  cortex.  Opposite  23  is  seen  a  small  soli- 
tary Betz  cell,  and  opposite  24  is  another  solitary  Betz  cell 
which  is  on  the  anterior  aspect  of  the  gyrus.  Between  it  and 
the  last  described  cell  are  quite  a  number  of  large  cells  interme- 
diate in  type  between  the  Betz  cell  and  the  largest  pyramidal 
cells.  Opposite  25  is  still  another  solitary  Betz  cell.  Then 
comes  a  region  for  a  considerable  distance  in  which  are  seen 
several  large  cells  at  this  level,  but  hardly  large  enough  to  be 
considered  as  Betz  cells  until  we  reach  that  part  of  the  cortex 
on  the  anterior  aspect  of  the  convolution  opposite  26,  where  we 
see  a  group  of  two  made  up  of  a  large  Betz  cell  and  a  smaller  one. 


DEMENTIA  PARALYTICA.  47 

Finally  below  this,  at  a  considerable  distance  and  opposite  27, 
is  a  group  of  three  Betz  cells,  the  one  in  the  middle  being  large, 
and  the  other  two  small.  It  will  be  seen  that  the  Betz  cells  are 
larger  and  more  numerous  on  the  posterior  aspect  of  the  gyrus 
than  upon  the  anterior  aspect.  There  are  thirty-one  groups  of 
these  cells  in  all,  13  of  which  contain  but  a  solitary  cell,  so  can 
hardly  be  considered  as  a  group,  though  of  cpurse  many  of  them 
form, part  of  a  group,  the  remaining  cells  being  in  another 
plane.  Ten  of  these  groups  contain  two  cells  each,  5  cells  each, 
and  but  two  groups  have  four  cells  each,  and  one  group  has  five 
cells,  making  61  Betz  cells  in  all  in  this  section.  Beginning  pos- 
teriorly and  following  around  to  the  lowest  group  on  the  ante- 
rior surface,  the  number  of  cells  in  each  group  as  seen  in  the 
same  plane  is  as  follows  : — i,  2,  2,  i,  i,  i,  3,  2,  1,2,  3,  2,  4,  4,  i,  3, 
I,  I,  2,  2,  2,  I,  5,  I,  2,  3,  I,  I,  1,2  and  3.  These  cells  lie  deeper 
in  the  cortex  and  thus  at  a  greater  distance  from  the  surface  in 
the  posterior  aspect  of  the  gyrus  than  at  the  vertex  or  at  the  an- 
terior aspect.  Of  course  the  number  of  cells  in  this  one  plane 
does  not  represent  in  every  case  all  the  cells  in  a  group,  but  only 
those  in  this  particular  plane.  As  many  of  these  groups  are 
more  or  less  spherical  no  one  plane  wall  show  more  than  a  part 
of  such  a  group,  and  as  stated  above  some  of  these  solitary  cells 
are  the  outer  members  of  some  of  these  groups. 

Plate  III,  Fig.  8,  as  previously  stated,  shows  the  strip  a  of 
Plate  III,  Fig.  7,  under  a  magnification  of  100  diameters  and  in 
strong  contrast  to  Plate  II,  Fig.' 3,  is  to  be  seen  the  much  larger 
number  of  neuroglia  cells,  the  methylene  violet  stain  seeming  to 
have  a  stronger  affinity  for  the  neuroglia  cells  than  the  methyl- 
ene blue  stain.  The  cortex  in  this  plate  is  also  seen  to  be  more 
condensed  and  not  so  deep  as  in  Plate  II,  Fig.  3.  The  first  layer 
measure  but  .20  mm.  in  thickness  in  contrast  to  .25  mm.  in  the 
above  mentioned  plate.  In  this  layer  neuroglia  cells  are  more 
numerous,  with  a  few  scarcely  scattered  nerve  cells  only  to  be 
made  out  under  high  magnification,  and  similar  to  those  found 
in  the  first  layer  in  Plate  II,  Fig.  3.  The  second  or  pyramidal 
cell  layer  is  of  special  importance  and  interest.  It  is  deeper 
than  the  corresponding  layer  in  Plate  II,  Fig.  3,  measuring  1.75 
mm.  in  thickness  as  contrasted  to  1.40  mm.  in  the  former.  Here 
too  in  addition  to  the  large  and  small  pyramidal  cells  are  found 
the  giant  pyramidal  or  Betz  cells,  irregularly  distributed,  singly 
or  in  groups,  and  at  different  levels,  so  that  it  is  impossible  to 
describe  them  as  forming  a  distinct  layer,  although  in  this  plate, 
with  the  exception  of  one  cell,  at  a  they  appear  to  be  placed  in 
the  lower  part  of  this  portion  of  the  cortex  now  being  described. 
In  taking  one  section  after  another,  however,  it  will  be  found 
that  these  cells  are  located  at  different  levels,  the  majority  be- 
ing in  the  lower  portion  of  this  second  layer.    They  furthermore 


48  G.  ALFRED  LAWRENCE. 

have  a  tendency  to  be  arranged  in  groups  containing  from  two 
to  ten  cells,  rarely  more,  and  finally  we  find  some  sections  con- 
taining no  Betz  cells  at  all.  The  pyramidal  cells  in  the  motor 
area  are  found  to  be  larger  in  size  on  an  average  than  those  of 
the  frontal  region.  The  chromatic  substance  is  not  arranged  in 
such  large  distinct  bodies  as  in  the  Betz  cells,  but  may  be  seen 
distributed  in  clumps  of  finer  or  coarser  granules  in  different 
parts  of  the  cell-body,  especially  about  the  nucleus  and  about 
the  base,  and  at  the  beginning  of  the  dendritic  processes  in 
the  cell-body.  Fig.  M  (M,  of  Plate  III,  Fig.  8),  shows  one  of 
these  cells  under  a  high  power,  X1300  (No.  3,  ocular,  1-12  inch 
oil  immersion  objective.  Leitz).  Here  the  finely  granular  chro- 
matic substance  is  distributed  in  a  ring  about  the  nucleus,  a 
clump  is  seen  at  the  base  to  the  left  where  a  dendritic  process  is 
given  off  and  also  clumps  are  seen  at  the  base  of  the  dendritic 
process  on  the  right  and  other  clumps  in  the  upper  part  of  the 
cell-body  and  in  the  apical  process.  In  addition  to  this,  small 
sized  linear  and  rounded  chromophilic  bodies  are  seen  in  the 
upper  part  of  the  cell-body  and  apical  process  and  also  in  the 
dendritic  processes  given  ofif  at  the  base.  The  nucleus  here  is 
large,  rounded,  centrally  placed,  and  contains  a  round,  deeply 
stained,  prominent  nucleolus,  surrounded  by  slightly  stained 
homogeneous  nuclear  substance.  In  some  cells  the  finely  gran- 
ular chromatic  substance  predominates  in  the  cell-body,  while 
in  others  the  small  chromophilic  bodies  are  more  prominent, 
whereas  the  majority  contain  both,  as  in  the  above  described 
cell.  In  some  of  the  smaller  pyramidal  cells  the  large  nucleus 
almost  fills  up  the  cell-body,  with  but  a  narrow  rim  of  finely 
granular  chromatic  substance  surrounding  the  same  and  ex-, 
tending  into  the  apical  and  basal  processes.  These  latter  cells 
would  be  classified  under  the  group  of  karyochrome  nerve  cells ; 
whereas  the  larger  pyramidal  cells  with  the  stainable  substance 
arranged  in  strife  in  the  same  direction  as  the  contour  of  the 
cell-body  come  under  the  head  of  the  stichochrome  nerve  cells 
of  the  somatochrome  class.  Turning  to  the  Betz  cells  and  ex- 
amining these  under  a  high  power  (No.  3  ocular  1-12  inch  oil 
immersion  objective,  Leitz.  X1300)  they  are  seen  to  contain 
numerous  distinct  chromophilic  bodies  varying  in  size  and  shape. 
In  Fig.  N  (N,  of  Plate  III,  Fig.  8)  the  upper  part  of  the  cell  is 
not  included  in  this  section.  From  below  are  seen  two  dendritic 
processes  given  off  from  the  under  side  of  the  cell-body,  that  is 
having  the  cell-body  from  a  lower  plane  than  figured  in  the 
drawing,  upon  the  right  side ;  and  one  slightly  larger  process 
from  the  left  side.  These  at  intervals  contain  distinct  chromo- 
philic granules,  for  the  most  part  linear  in  shape,  with  the  long 
axis  parallel  to  the  axis  of  the  process  and  extending  for  a  con- 
siderable distance  into  the  process — as  far  as  they  could  be 


Table  II. 
Nerve  Cell  and  Neuroglia  Cell  Counts  by  Ocular  Net-Micrometer. 


THICK- 
NESS      OF 

SECTION 
IN          MI- 
CRONS 

AVERAGE     NO. 

AVERAGE     NO. 

BRAIN. 

REGION. 

NERVE    CELLS 

TO    SQUARE 

MM. 

NEUROGLIA 

CELLS    TO 

SQUARE    MM. 

Brain 

A. 

First    Frontal 

6.6 

116.85 

125.00 

Brain 

A. 

First    Frontal 
Ant.       Cent. 

Upper 

10 

127.00 

164.00 

Brain 

A. 

Third 
Ant.       Cent. 

Upper 

10 

95.00 

293.00 

Brain 

A. 

Third 

Ant.       Cent. 

Lower 

10 

94.00 

84.00 

Brain 

A. 

Third 
Post.     Cent. 

Middle 

10 

108.00 

248.00 

Brain 

A. 

Third 

6.6 

185.00 

109.20 

Brain 

A. 

First  Tempora 

1 

6.6 

146.00 

131.90 

Brain 

A. 

Parietal 

6.6 

104.00 

180.90 

Brain 

A. 

Occipital 

6.6 

164.00 

199.00 

Brain 

B. 

First  Frontal 

6.6 

100.00 

56.90 

Brain 

B. 

First  Frontal 
Ant.       Cent. 

Upper 

10 

82.91 

303.00 

Brain 

B. 

Third 
Ant.       Cent. 

Upper 

6.6 

39.60 

204.0c 

Brain 

B. 

Third 
Ant.       Cent. 

Upper 

ID 

49.10 

300.0c 

Brain 

B. 

Third 
Ant.       Cent. 

Upper 

10 

55-50 

305.00 

Brain 

B. 

Third 
Ant.       Cent. 

Upper 

ID 

53-50 

4330 

Brain 

B. 

Third 
Ant.       Cent. 

Upper 

lO 

36.50 

289.00 

Brain 

B. 

Third 
Ant.       Cent. 

Lower 

6.6 

59.20 

320.00 

Brain 

B. 

Third. 

10 

46.60 

236.00 

Brain 

B. 

Post.     Cent. 

Middle 

Third 

6.6 

59.91 

134-37 

Brain 

B. 

First    Temporal 

6.6 

56.74 

205.90 

Brain 

B. 

Parietal 

6.6 

68.63 

192.70 

Brain 

B. 

Occipital 

6.6 

62.50 

215.01 

Table  III. 


Plate  III. 

Fig.  7 

Plate  IV. 

Fig.  9 

Plate  IV.          ^'^-  "■ 

NO.   OF  CELLS   IN 

NO.   OF  CELLS   IN 

NO.   OF  CELLS   IN 

GROUP. 

GROUP 

GROUP. 

EACH  GROUP. 

EACH  GROUP. 

EACH   GROUP. 

I. 

I. 

I. 

I. 

I. 

3- 

II. 

2. 

II. 

4- 

II. 

I. 

III. 

2. 

III. 

I. 

III. 

3- 

IV. 

I. 

IV. 

3- 

IV. 

I. 

V. 

I. 

V. 

I. 

V. 

I. 

VI. 

I. 

VI. 

I. 

VI. 

I. 

VII. 

3- 

VII. 

3- 

VII. 

2.  17  Groups  on 

VIII. 

2. 

VIII. 

2. 

VIII. 

I.  Posterior As- 

IX. 

I. 

IX. 

2. 

IX. 

I.  pect   of    Gy- 

X. 

2.  25  Groups  on 

X. 

2.  19  Groups  on 

X. 

I.  rus.  Total  of 

XI. 

3.  Posterior  As- 

XL 

I.  Posteri- 

XL 

2.  27  Cells. 

XII. 

2.  pect    of     Gy- 

XII. 

2.  or  Aspect  of 

XII. 

2. 

XIII. 

4.  rus. 

XIII. 

I.  Gyrus.      To- 

XIII. 

I. 

XIV. 

4. 

XIV. 

I.  tal       of      37 

XIV. 

3- 

XV. 

I.  Total    of     so 

XV. 

3.  Cells. 

XV. 

2. 

XVI. 

3.  Cells. 

XVI. 

I. 

XVI. 

I. 

XVII. 

I. 

XVII. 

I. 

XVII. 

I. 

XVIII. 

I. 

XVIII. 

6. 

XIX. 

2. 

XIX. 

I. 

XVIII. 

2. 

XX. 

2. 

XIX. 

8. 6    Groups    on 

XXI. 

2. 

XX. 

9.  2  Groups  on 

XX. 

3.  Vertex   of 

XXII. 

I. 

XXI. 

6.  Vertex       0  f 

XXL 

2.  Gyrus.    Total 

XXIII. 

5- 

Gyrus.   Total 

XXII. 

2.  of  19  Cells. 

XXIV. 

I. 

of  15  Cells. 

XXIII. 

2. 

XXV. 

2. 

XXII. 

I.  2   Groups   on 

XXIV. 

4.  6   Groups   on 

XXVI. 

3.  2    Groups    on 

XXIII. 

6.  Ant.     Aspect 

XXV. 

I.  Ant.      Aspect 

XXVII. 

I.  Vertex  of  Gy- 

of  Gyrus. 

XXVI. 

I.  of          Gyrus. 

rus.    Total  of 

Total     of     7 

XXVTT 

I.  Total      of     9 

4  Cells. 

Cells. 

XXVIII. 

I.  Cells. 

XXIX.       I. 

XXVIII. 

1.4   Groups    on 

XXIX. 

I.  Ant.      Aspect 

XXX. 

2.  of  Gyrus.  To- 

3.  of  7  Cells. 

XXXI. 

3 1— Tot. 

6i=Total     No. 

23— Tot. 

S9=Total     No. 

29z=Toi. 

55=Total     No. 

No.     of 

of  Cells. 

No.       of 

of  Cells. 

No.      of 

of  Cells. 

Groups 

Groups. 

Groups. 

DEMENTIA  PARALYTICA.  49 

traced  in  the  section.  About  the  middle  of  the  left  dendritic 
process  is  seen  a  large  irregular  chromophilic  body  at  a  point 
where  a  branch  is  probably  given  off,  as  wedge-shaped  chro- 
matic masses  are  often  found  at  the  point  of  branching  of  a  den- 
dritic process,  Nissl's  so-called  "wedges  of  division."  Within 
the  cell-body  the  granules  are  seen  to  be  elongated,  rounded  or 
irregular  in  shape,  the  first  mentioned  predominating;  some 
much  larger  than  others,  and  with  the  general  arrangement  of 
the  long  axis  parallel  to  the  sides  of  the  cell-body.  The  nucleus 
is  large,  well  defined,  and  placed  in  the  upper  part  of  the  cell- 
body  and  nearer  the  right  than  the  left  side.  There  is  a  well 
defined,  deeply  stained  nucleolus  centrally  placed  and  surrounded 
by  a  homogeneous,  slightly  colored  nuclear  substance,  with  no 
well  defined  network.  At  the  base  of  the  cell-body,  occupying  a 
space  somewhat  larger  than  the  cell  nucleus  is  a  deposit  of 
yellowish  pigment,  elliptical  in  outline,  and  entirely  displacing  all 
other  cell  contents.  No  other  pigment  is  to  be  found  in  this  cell. 
The  arrangement  of  the  chromophilic  granules  in  striae  in  the  same 
direction  as  the  contour  of  the  cell-body  classifies  it  as  a  sticho- 
chrome  nerve  cell  of  the  somatochrome  class.  Fig.o  (o  of  Plate  III, 
Fig.  8)  shows  another  of  these  Betz  cells  examined  under  the 
same  magnification  of  1,300  diameters  (No.  3  ocular,  1-12  in  oil 
immersion  lens,  Leitz),  in  which  the  arrangement  of  the  chro- 
mophilic bodies  in  striae  parallel  to  the  contour  of  the  cell-body 
is  very  well  marked.  This  arrangement  extends  far  out  in  the 
basal  process  and  high  up  in  the  apical  process.  The  nucleus  is 
situated  more  on  one  side  of  the  cell-body  than  the  other,  and  the 
nucleolus  is  not  included  in  this  plane.  There  are  three  dendritic 
processes  to  be  seen,  the  apical  extending,  for  a  considerable  dis- 
tance towards  the  periphery,  and  gradually  decreasing  in  size, 
and  two  basal  processes,  the  one  to  the  left  unbranched,  while 
the  one  on  the  right  gives  off  a  large  branch  shortly  after  leaving 
the  cell-body,  at  which  point  a  is  one  of  the  so-called  "wedges  of 
division"  of  Nissl.  There  is  no  pigment  in  this  cell,  but  in  the 
one  seen  just  below  this  in  Plate  III,  Fig.  8,  marked  P,  a  large 
mass  of  yellow  pigment  is  seen  above  and  to  one  side  of  the  nu- 
cleus at  the  base  of  the  apical  process.  There  are  but  few 
chromophilic  bodies  in  this  cell  compared  to  the  two  previously 
described,  the  chromatin  being  for  the  most  part  in  the  form  of 
fine  granules  arranged  in  larger  and  smaller  masses  in  different 
parts  of  the  cell.  The  Betz  cell  seen  lying  just  below  and  to  the 
right  of  this  latter,  and  marked  O  in  Plate  III,  Fig.  8,  also  con- 
tains a  small  mass  of  pigment  poorly  defined,  and  lying  just  below 
the  nucleus  at  the  base  of  the  cell.  The  other  Betz  cells  seen 
in  this  plate  contain  no  pigment.  While  discussing  the  Betz  cells, 
and  before  proceeding  to  the  description  of  the  third  layer,  sev- 
eral other  photomicrographs  will  be  described  as  illustrating  the 


50 


G.  ALFRED  LAWRENCE. 


grouping  and  structure  of  these  cells.  The  first  of  these,  Plate 
IV,  Fig.  9,  is  a  photomicrograph  magnified  14  diameters  of  a 
section  in  close  proximity  to  that  seen  in  Plate  III,  Fig.  7,  of  the 
same  size  as  this  latter  and  treated  in  the  same  way,  excepting 
that  methylene  blue  was  used  as  the  stain  here.  Opposite  a,  and 
enclosed  in  ink  lines,  is  the  segment  of  the  section  shown  in 
Plate  IV,  Fig.  10,  under  a  magnification  of  100  diameters.  The 
other  la5^er  is  seen  to  vary  in  thickness,  being  much  thicker  at  the 
posterior  aspect,  at  h,  than  at  the  vertex  or  the  anterior  aspect. 


f 

if    ' 

1         ■    1 

/a 

// 

/y 

A 

f 

/f 

D     ; 

B 

f  . 
1 

S 
J- 

¥ 
J 

P  L  S-  "f-"  €- 


3^ig.  J. 


At  c  and  d  the  second  layer  is  seen  at  the  surface,  due  no  doubt 
to  injury  in  manipulation,  probably  more  from  pressure  than 
actual  tearing,  as  the  surface  is  smooth  and  continuous  at  both 
ends,  with  the  adjacent  surfaces.  No  doubt  artefacts  similar  to 
this,  and  of  greater  or  less  extent,  must  be  carefully  guarded 
against  and  considered  in  all  work  upon  such  a  delicate  and  yield- 
ing tissue  as  the  brain,  especially  when  secured  within  a  few 
minutes  after  death,  as  in  this  case,  and  before  any  post-mortem 
fixity  results.  The  second  layer  shows  the  radial  arrangement 
of  the  cells,  but  the  most  conspicuous  feature  is  the  distribution 
and  arrangement  of  the  Betz  cells  contained  in  the  lower  part 


DEMENTIA  PARALYTICA.  5^ 

of  this  layer  singly  or  in  groups  of  varying  number  and  size. 
Below  this  the  less  conspicuous  third  layer  is  gradually  lost  to 
view  as  it  merges  into  the  white  medullary  substance.  The  ar- 
rangement of  the  Betz  cells  will  be  described  in  detail  as  photo- 
micrographs of  this  magnification,  14  diameters,  show  their  dis- 
tribution especially  well.  Beginning  at  the  posterior  portion  of 
the  convolution  below^  the  letter  h,  the  first  large  Betz  cell  is  to 
be  seen  opposite  the  figure  i,  and  is  solitary,  whereas  just  above 
and  opposite  2,  is  a  group  of  four  Betz  cells  all  of  about  the 
same  depth  of  the  cortex.  Above  this,  opposite  3,  is  a  large  soli- 
tary Betz  cell.  Opposite  4  is  a  group  of  three  cells  arranged 
radially  above  one  another.  Opposite  5  is  another  solitary  Betz 
cell.  Above  it  a  small  portion  of  a  Betz  cell  is  seen  which  lies 
mostly  in  another  plane,  while  below  it  small  portions  of  three 
Betz  cells  are  seen  lying  for  the  most  part  in  another  plane. 
Above  this,  and  opposite  6,  is  a  group  of  two  Betz  cells  at  the 
same  depth,  and  one  just  above  the  other.  Between  6  and  7  are 
seen  cells,  two  in  number,  w^hich  might  be  regarded  as  inter- 
mediate in  character  between  the  large  pyramidal  and  Betz  cells, 
having  a  similar  arrangement  of  chromophilic  substance,  but  of 
intermediate  size.  Opposite  7  is  a  group  of  two  Betz  cells,  and 
opposite  8  is  another  group  of  two  Betz  cells  somewhat  nearer 
the  surface,  and  just  under  this  latter  group  and  deeper  in  the 
cortex  is  a  solitary  Betz  cell.  Opposite  9  is  a  group  of  two  Betz 
cells,  only  a  very  small  portion  of  the  upper  cell  being  seen  in  this 
plane.  Opposite  10,  a  portion  of  a  solitary  Betz  cell  is  seen,  and 
opposite  II  is  still  another  solitary  Betz  cell.  Opposite  12  is  a 
group  of  three  Betz  cells,  and  just  to  the  right  of  this  and  at  the 
same  level,  is  a  part  of  a  solitary  Betz  cell,  while  nearer  to  the 
surface  and  in  the  same  radial  line  is  still  another  small  solitary 
Betz  cell.  Opposite  13  is  a  group  of  six  Betz  cells,  two  of  which 
are  large,  and  appear  very  prominently,  the  other  four  lying 
somewhat  to  the  right,  being  smaller,  but  having  the  characteris- 
tic structure  of  the  Betz  cells.  Opposite  14  is  a  solitary  Betz 
cell,  and  next  we  come  to  the  two  groups  seen  under  a  magnifica- 
tion of  100  diameters  in  Plate  IV,  Fig.  10,  and  in  this  plate  seen 
enclosed  in  ink  lines  and  opposite  figures  15  and  16.  The  first 
group,  or  that  opposite  15,  contains  nine  well  defined  Betz  cells, 
while  the  adjacent  group,  opposite  16,  contains  six  Betz  cells, 
three  large  cells  and  the  segments  of  three  others,  the  greater 
part  of  these  latter  lying  in  another  plane.  Opposite  17  are  four 
scattered  cells  at  about  the  same  depth  of  the  cortex,  and  inter- 
mediate in  size  and  structure,  between  the  large  pyramidal  and 
the  Betz  cells.  Opposite  18  is  a  large  solitary  Betz  cell,  above 
and  below  it  being  the  cells  intermediate  in  type  just  described. 
At  19  is  a  group  of  six,  made  up  of  one  large  Betz  cell  and  five 
smaller  ones  about  it.    Above  and  below  this  are  other  pyramidal 


52 


G.  ALFRED  LAWRENCE. 


cells  at  this  level,  and  of  the  above  described  intermediate  type. 
There  are  in  all  fifty-nine  of  these  Betz  cells  in  this  section,  ar- 
ranged singly  or  in  groups;  beginning  posteriorly  at  i,  and 
proceeding  around  to  the  anterior  and  last  group  at  19,  as  fol- 
lows:  I,  4,  I,  3,  I,  I,  3'  2,  2,  2,  I,  2,  I,  I,  3,  I, 
I,  6,  I,  9,  6,  I  and  6,  thus  making  twenty-three  groups  in  all, 
eleven  of  which  contain  solitary  cells,  four  contain  two  cells,  three 


Flate  IV,  Fig.  10 

contain  three  cells,  one  contains  four  cells,  three  contain  six  cells, 
and  one  nine  cells,  in  the  plane  of  this  section.  Of  these  cells  thirty 
contain  distinct  pigmentary  deposits,  these  being  practically  all 
of  the  larger  cells.  Quite  a  number  of  the  others  in  the  plane  of 
the  main  portion  of  the  cell  would  undoubtedly  also  contain  pig- 
mentary deposits.  The  grouping,  of  course,  is  here  described  for 
only  the  plane  of  this  section  and  the  probability  is  that  some  at 


DEMENTIA  PARALYTICA. 


53 


least  of  these  solitary  cells  are  a  part  of  a  group,  the  remaining 
cells  lying  in  another  plane.  Furthermore,  some  of  the  groups 
described  may  contain  additional  celb  lying  in  the  plane  above  and 
below  that  of  this  section.  Plate  IV.  Fig.  lo,  previously  men- 
tioned, has  a  magnification  of  lOO  diameters,  and  includes  the  strip 
a  outlined  in  ink  in  Plate  IV.  Fig.  9.  Two  groups  of  Betz  cells 
are  seen,  one  containing  nine  and  the  other  six  cells.  Two  other 
cells,  a  and  b,  though  smaller  yet  in  structure  approach  in  charac- 


/I 

/2- 

? 

B  ' 

•      1 

i 

4' 

Plate  IV,  Fig.  11 


ter  the  Betz  cells.  It  will  be  noticed  that  the  cortex  is  not  so  deep 
in  this  plate,  the  first  layer  being  but  .175  mm.  in  thickness,  and 
the  second  but  1.20  mm.  in  thickness  in  comparison  to  .20  and  1.75 
mm.,  respectively,  in  Plate  III.  Fig.  8.  It  will  be  noted,  however, 
that  this  strip  was  taken  from  the  vertex  of  the  section  where 
the  cortex  is  not  so,  deep  as  on  the  posterior  aspect  from  which 
Plate  III.  Fig.  8  was  taken.  These  two  groups  of  Betz  cells  are 
but  1.20  mm.  from  the  surface  of  the  cortex  here  in  contrast  to 
1.70  mm.  in  Plate  III.  Fig.  8,  showing  the  variability  in  thickness 
of  the  cortex  in  close  proximity,  as  both  plates  were  made  from 


54  G-  ALFRED  LAWRENCE. 

sections  cut  from  the  same  block  which  was  not  more  than  half  a 
centimeter  in  thickness.  The  Betz  cells  here  have  the  same 
structural  characteristics  as  those  described  in  Plate  III.  Fig.  8, 
and  five  of  the  cells,  marked  c,  d,  e,  f,  and  g,  of  the  larger  group, 
and  two  of  the  cells,  marked  i  and  /,  of  the  smaller  group,  contain 
distinct  yellowish  pigment.  The  larger  of  the  two  groups  and 
containing  nine  Betz  cells  is  made  up  of  two  very  large  cells  cut 
in  the  plane  of  the  nucleus,  four  smaller  cells  also  cut  in  the  plane 
of  the  nucleus,  while  the  remaining  three  cells  show  only  a  small 
portion  of  the  body  of  each  cell  here,  the  large  portion  of  these 
latter  being  in  another  plane.  Five  of  these  nine  cells  contain  de- 
posits of  pigment,  and  all  show  the  chromophilic  granules,  being 
seen  especially  well  in  the  cells  marked  c,  d,  e,  and  h.  The  cells  in 
this  group  are  quite  close  to  one  another  and  do  not  take  up  a  very 
large  space.  The  smaller  group  to  the  left  contains  six  Betz  cells, 
three  large  and  conspicuous,  and  three  others,  one  to  the  right  and 
two  to  the  left  of  these  large  cells  which  lie  only  partially  in  this 
plane  and  are  small  in  size.  Two  of  the  three  large  cells  marked 
i  and  /  contain  deposits  of  yellowish  pigment  at  the  base  of  the 
body  of  the  cell,  and  all  contain  well  defined  chromophilic  bodies. 
Plate  IV.  Fig.  ii  is  another  photomicrograph  of  a  section  from 
the  same  block  as  that  from  which  the  sections  represented  in 
Plate  III.  Fig.  7,  and  Plate  IV.  Fig.  9,  were  taken.  This  section 
is  10  microns  in  thickness,  stained  with  methylene  blue  and  other- 
wise similarly  treated  as  the  above  mentioned  plates.  This  mag- 
nification of  14  diameters  shows  the  outer  layer  to  be  fairly  uni- 
form in  thickness,  excepting  at  the  points  h  and  c.  At  h  it  is  of 
relatively  the  same  thickness  as  at  the  same  point  b  in  Plate  IV. 
Fig.  9,  about  one  and  one-half  times  as  thick  as  at  d  into  which 
it  gradually  merges.  At  c  where  no  outer  layer  is  to  be  seen  in 
Plate  IV.  Fig.  9,  here  the  outer  layer  is  distinctly  seen  but 
somewhat  thinner  than  on  either  side,  showing  the  artefact  to  be 
less  in  degree  in  this  section.  At  a  the  group  of  cells  represented 
in  Plate  V.  Fig.  13,  is  seen,  and  each  cell  can  easily  be  distinguish- 
ed and  counted  under  this  magnification  of  14  diameters.  The 
second  layer  here  is  also  especially  interesting  in  respect  to  the 
size,  number  and  distribution  of  the  Betz  cells  singly  or  in  groups 
in  the  lower  portion  of  the  layer  near  the  transition  into  the  third 
or  spindle  cell  layer.  This  latter  is  less  distinct  and  lost  below 
in  the  medullary  white  substance  in  the  interior  of  the  gyrus.  A 
detailed  description  of  the  arrangement  of  these  Betz  cells  will  be 
given  in  order  to  compare  the  same  with  those  of  Plate  III.  Fig.  7, 
and  Plate  IV.  Fig.  9.  Beginning  with  the  first  group  at  the  lowest 
part  of  the  section  on  the  right,  which  is  the  posterior  surface 
of  the  gyrus,  opposite  I,  is  seen  a  group  of  three  large  Betz  cells. 
Above  this  some  distance  opposite  2,  is  a  solitary  Betz  cell.  Op- 
posite 3,  is  another  group  of  three  Betz  cells  at  a  slightly  greater 


DEMENTIA  PARALYTICA.  55 

depth.  Above  this  and  opposite  4  and  5,  respectively,  are  large 
solitary  Betz  cells.  Then  there  is  a  considerable  interval  where 
there  are  a  number  of  large  pyramidal  cells  but  scarcely  approach- 
ing the  size  of  a  Betz  cell  until  the  point  opposite  6  is  reached 
where  a  large  solitary  Betz  cell  is  seen  and  just  above  it  a  group 
of  two  Betz  cells  somewhat  smaller  in  size  is  to  be  noted.  Oppo- 
site 7  is  a  solitary  Betz  cell  at  a  greater  depth.  Just  above  this 
and  slightly  nearer  the  surface  are  several  intermediate  type  cells 
arranged  in  two  rows,  one  at  a  slightly  greater  depth  than  the 
other.  Opposite  8  and  at  the  same  level  as  the  preceding  is  a 
solitary  Betz  cell,  and  above  this  opposite  9  is  a  larger  solitary 
Betz  cell.  At  the  same  depth  and  slightly  nearer  the  vertex  is  a 
group  of  two  Betz  cells,  one  large  and  the  other  small.  About 
midway  between  these  and  the  surface  of  the  cortex  are  seen  sev- 
eral very  large  pyramidal  cells,  the  so-called  intermediate  type 
between  the  Betz  cells  or  giant  pyramidal  cells  and  the  ordinary 
sized  large  pyramidal  cells.  Opposite  10  is  seen  a  group  of  two 
very  large  Betz  cells  just  below  and  to  one  side  of  a  large  blood 
vessel.  Just  above  this  and  nearer  the  surface  is  a  small  solitary 
Betz  cell.  Opposite  11  are  three  groups  of  Betz  cells,  the  first  con- 
taining three,  the  second  two,  and  the  third  above  and  nearer  the 
surface  consisting  of  a  large  solitary  Betz  cell.  Opposite 
12  is  a  large  solitary  Betz  cell,  considerably  nearer  the 
surface  than  the  groups  just  described.  A  group  of  two  large 
Betz  cells,  one  just  above  the  other,  is  seen  opposite  13.  This 
brings  us  to  the  large  group  opposite  a  and  seen  under  a  magni- 
fication of  850  diameters  in  Plate  V.  Fig.  13,  containing  eight 
Betz  cells  which  will  be  described  in  detail  later  when  discussing 
this  latter  plate.  To  the  left  of  this  group  opposite  14  are  seen 
three  Betz  cells  of  small  size  and  somewhat  separated  from  one 
another.  To  the  left  of  these  at  a  short  distance  are  seen  two 
Bfetz  cells,  one  above  the  other.  Opposite  15  are  seen  two  groups 
of  two  each,  the  cells  in  the  first  group  being  somewhat  separated 
from  one  another  and  one  above  the  other.  Opposite  16  is  a  well 
marked  group  of  four  Betz  cells,  two  being  very  large  and  the 
other  two  smaller  in  size.  Below  this  and  upon  the  anterior  sur- 
face of  the  gyrus  opposite  17  are  two  solitary  Betz  cells,  one 
lower  than  the  other  and  nearer  the  surface.  Opposite  18  is  still 
another  smaller  solitary  Betz  cell  at  a  greater  depth.  For  some 
distance  below  this  no  Betz  cells  are  to  be  seen  until  opposite  19  is 
a  solitary  Betz  cell.  Just  below  this  and  slightly  nearer  the  sur- 
face is  a  group  of  three  of  the  intermediate  sized  cells.  Opposite 
20  are  two  large  solitary  Betz  cells,  the  lower  larger  one  being  at 
a  slightly  greater  depth.  Then  comes  another  region  barren  of 
these  cells  until  the  point  opposite  21  is  reached  where  a  small 
solitary  intermediate  size  cell  is  seen,  and  below  this  a  group  of 
two  of  these  same  cells  is  to  be  noted,  one  at  a  greater  depth  than 


56  G.  ALFRED  LAWRENCE. 

the  other.     Opposite  22  is  a  very  large  solitary  Betz  cell.     Just 
below  this  are  two  intermediate  size  cells,  and  still  below  this 
and  at  a  slightly  greater  depth  are  three  of  these  intermediate  size 
cells.    This  includes  all  the  Betz  cells  though,  as  above  noted,  here 
and  there  in  different  parts  of  this  layer;  but  for  the  most  part 
in  the  same  relative  position,  are  to  be  seen  very  large  pyramidal 
cells  approximating  these  Betz  cells  both  in  size  and  structure, 
and  the  writer  thinks  should  be  regarded  as  intermediate  in  type 
between  the  large  pyramidal  cells  and  the  giant  pyramidal  or  Betz 
cells, — a  transition  form,  if  they  might  be  so  called.     There  are 
twenty-eight  groups  of  these  Betz  cells  in  all  in  this  plate,  varying 
in  number  from  one  to  eight  cells  in  each  group,  one  to  three  being 
the  usual  number.     Fourteen  of  these  groups  contain  but  one  cell 
each,  and  these  so-called  solitary  cells  are  usually  of  large  size. 
There  are  eight  groups  containing  two  cells  each,  four  groups  of 
three  cells   each,  but  one  group  containing  four  cells,   and  one 
group  containing  eight  cells.     Taking  the  groups  from  the  lower 
portion  of  the  posterior  surface  in  succession,  as  above  described, 
and  the  number  of  cells  in  each  of  the  twenty-nine  groups  is 
found  to  be  as  follows :    3,  i,  3,  i,  i,  i,  2,  i,  i,  i,  2,  2,  i,  3,  2,  i,  i, 
2,  8,  3,  2,  2,  2,  4,  I,  I,  I,  I,  I,  making  a  total  of  fifty-five  Betz  cells 
in  the  section,  and  thus  averaging  about  two  cells  to  each  group. 
The  number  of  groups  is  somewhat  more  than  in  Plate  IV.  Fig.  9, 
in  which  there  were  twenty-three  groups  containing  in  all  fifty- 
nine  Betz  cells,  and  somewhat  less  than  in  Plate  III.  Fig.  7,  where 
there  are  thirty-one  groups  containing  sixty-one  cells.     It  will 
thus  be  seen  that  the  average  number  of  groups  and  total  number 
of  cells  in  these  three  sections  from  near-by  portions  of  the  same 
block  are  fairly  uniform  in  regard  to  the  arrangement  and  dis- 
tribution of  the  Betz  cells.     It  is  to  be  noted  that  more  cells  are 
found  on  the  posterior  aspect  of  the  gyrus  than  on  the  anterior. 
In  Plate  III.  Fig.  7,  there  are  fifty  cells  arranged  in  twenty-five 
groups  on  the  posterior  aspect  of  the  gyrus,  with  but  four  cells  in 
two  groups  at  the  vertex,  and  seven  cells  in  four  groups  on  the 
anterior  aspect.     In  Plate  IV.  Fig.  9  there  are  thirty-seven  cells 
arranged  in  nineteen  groups  on  the  posterior  aspect  of  the  gyrus, 
fifteen  cells  in  two  groups  at  the  vertex,  and  seven  cells  in  two 
groups  on  the  anterior  aspect.    Finally,  in  Plate  IV.  Fig.  11,  there 
are  twenty-seven  cells  arranged  in  seventeen  groups  in  the  pos- 
terior aspect  of  the  gyrus,  nineteen  cells  in  six  groups  at  the  ver- 
tex, and  nine  cells  arraned  in  six  groups  on  the  anterior  aspect. 
It  will  thus  be  seen  that  most  of  the  Betz  cells  are  on  the  pos- 
terior aspect  of  the  gyrus  and  gradually  diminish  in  number  upon 
approaching  the  vertex  until  upon  the  anterior  aspect  there  are 
but  few  to  be  seen.     Table  III.  shows  the  above  results  in  tabu- 
lated form.    Upon  referring  to  this  latter  it  will  be  seen  that  the 
average  number  of  cells  in  each  section  is  fairly  uniform — 55,  59 


DEMENTIA  PARALYTICA. 


57 


and  6i  for  the  three  sections ;  the  grouping  is  somewhat  more 
variable — 23,  29  and  31,  most  of  the  cells  singly  or  in  groups  of 
two  or  more  being  upon  the  posterior  aspect  and  vertex.  This 
corresponds  to  the  findings  of  Lewis  and  Clarke  ('78)  who  ex- 
amined sections  from  various  parts  of  the  left  anterior  central  con- 
volution and  the  posterior  portion  of  the  two  upper  frontal  con- 


Plate  V,  Fig.  13 


volutions  on  the  same  side  in  several  human  brains  microscop- 
ically, and  made  diagrams  of  the  distribution  of  the  Betz  cells  at 
various  points  instead  of  employing  photomicrographs  showing 
the  number,  arrangement  and  relation  to  other  elements  of  the 
cortex  of  these  Betz  cells  as  in  this  article.  Plate  V.  Fig/  13  is 
a  beautiful  photomicrograph  of  a  group  of  these  Betz  cells  mag- 
nified 825  diameters  and  taken  from  the  point  marked  a  in  Plate 
IV.  Fig.  II.    Here  is  seen  a  "nest,"  or  group  of  these  cells,  eight 


58  G.  ALFRED  LAWRENCE. 

in  number.  All  of  these  Betz  cells  contain  pigment  excepting  the 
one  marked  a  which  in  size  is  not  much  larger  than  one  of  the 
large  pyramidal  cells,  but  in  structure  resembles  the  Betz  cells. 
This  pigment,  varying  in  amount,  is  situated  at  the  base  of  the 
cell  below  the  nucleus,  excepting  in  the  cell  marked  h  where  it  is 
just  above  the  nucleus.  In  the  cell  marked  c  it  extends  down  into 
the  large  basal  dendritic  process,  given  off  to  the  right  for  a  short 
distance.  In  the  cells  marked  c,  d,  e,  f  and  g,  the  cell  body  appears 
of  a  lighter  color  in  the  photomicrograph  where  this  yellowish  pig- 


Plate  IV,  Fig.  12 

mentary  deposit  is  found.  The  cell  marked  c,  sectioned  outside  of 
the  plane  of  the  nucleus,  shows  very  well  the  general  arrangement 
of  the  rounded  or  elongated  chromophilic  bodies  in  a  direction 
parallel  to  the  contour  of  the  cell-body,  thus  classifying  it  with 
the  others  of  similar  type  as  stichochrome  nerve  cells  of  the 
somatochrome  class.  The  cell  marked  e  shows  the  general  parallel 
arrangement  of  the  chromophilic  bodies  in  the  apical  process  very 
well.  The  group,  as  a  whole,  is  very  compact  and  as  each  cell  is 
cut  in  a  somewhat  different  plane  from  the  others  most  of  the 
features  of  such  a  "nest"  are  thus  brought  out.  Of  course,  there 
may  be  other  cells  in  this  group  lying  outside  of  the  ones  seen  here 
— in  the  planes  above  and  below  this.    Plate  IV.  Fig.  12  is  a  pho- 


DEMENTIA  PARALYTICA. 


59 


tomicrograph  of  a  Betz  cell  magnified  1,400  diameters  from  a  sec- 
tion adjacent  to  and  upon  the  same  slide  as  that  from  which  Plate 
III.  Fig.  8  was  taken.  The  section  is,  therefore,  similar  in  shape 
to  the  one  in  Plate  III.  Fig.  7,  and  this  cell  is  situated  in  a  posi- 
tion opposite  to  the  letter  d,  and  in  the  lower  portion  of  the  second 


Plate  V,  Fig.  14 


or  p3Tamidal  cell  layer  of  this  latter.  The  section  is  ten  microns 
in  thickness  and  stained  with  methylene  violet.  It  can  readily  be 
appreciated  from  this  photomicrograph  that  only  an  extremely 
thin  plane  can  be  seen  under  such  a  high  magnification  and  not 
all  of  this  even  will  be  in  sharp  focus.  The  nucleus  here  is  mostly 
below  the  plane  of  the  section  and  the  deeply  stained  nucleolus  en- 
tirely so.  Two  dendritic  processes  are  faintly  seen  coming  off 
from  the  base  of  the  cell,  the  one  on  the  right  but  faintly  shown 
as  it  is  at  a  different  level  for  the  most  part.    The  one  on  the  left 


6d  G.  ALFRED  LAWRENCE. 

is  somewhat  more  distinct  and  chromophilic  bodies  are  found  to 
enter  the  base  and  extend  for  a  considerable  distance  into  the 
same.  These  bodies  of  varying  size  and  in  general  rounded  or 
linear  in  shape,  are  closely  packed  in  most  parts  of  the  cell-body, 
excepting  at  the  base  where  a  large  deposit  of  yellowish  pigment, 
taking  up  about  the  same  area  of  space,  as  the  nucleus,  is  to  be 
found.  These  chromophilic  bodies  are  arranged  in  general  par- 
allel to  the  contour  of  the  cell-body  and  extend  into  both  the 
basal  dendritic  processes  and  the  apical  process  as  far  as  they  can 
be  traced.  A  portion  of  another  Betz  cell  smaller  in  size  is  seen 
above  and  to  the  left.  About  the  larger  cell  are  several  neuroglia 
cells  singly  or  in  groups,  and  these  are  seen  to  be  distinctly  round- 
ed or  oval  with  usually  a  ring  of  chromatic  substance  of  varying 
thickness  at  the  periphery  and  several  irregular  deeply  stained 
bodies  in  the  center.  Twenty  neuroglia  cells  in  all  are  seen  in 
this  plate.  Plate  V.  Fig.  14,  is  a  photomicrograph  of  the  same 
magnification, — 1,400  diameters, — as  the  preceding  and  taken 
from  a  section  of  the  same  block.  The  section  of  the  same 
form  and  size  as  that  seen  in  Plate  III.  Fig.  7,  is  ten  microns  in 
thickness,  and  stained  with  methylene  blue  instead  of  methylene 
violet,  but  otherwise  treated  in  exactly  the  same  way.  One 
noticeable  point  about  this  plate  is  the  absence  of  neuroglia  cells, 
in  marked  contrast  to  Plate  IV.  Fig.  12,  indicating  again  that  the 
neuroglia  cells  do  not  retain  the  methylene  blue  stain  with  the 
same  intensity  as  when  similarly  treated  with  methylene  violet. 
Here  is  seen  a  group  of  two  Betz  cells,  the  upper  one,  at  this 
plane  broadly  pyramidal  in  shape,  and  the  lower  one  presenting 
an  irregular  spindle  shape.  This  latter,  however,  is  only  the  base 
of  the  cell,  the  process  above  and  to  the  left  and  that  below  and  to 
the  right  being  basal  dendritic  processes,  and  the  apical  dendritic 
process  extending  upward  beyond  the  base  of  the  upper  cell  in  a 
different  plane.  There  are  two  other  Betz  cells  just  above  and 
slightly  to  the  right  of  these  cells  in  the  section,  not  shown  in  the 
plate,  thus  making  the  group  consist  of  four  cells  in  all.  Both  of 
these  cells  are  cut  in  the  plane  of  the  nucleus  and  large,  rounded, 
deeply  stained  nucleolus.  The  nuclear  body  also  contains  some 
chromatic  substance  arranged  in  an  indefinite  network.  At  the 
base  of  the  lower  cell  and  extending  into  the  large  basal  dendrite 
to  the  right  as  far  as  it  is  seen  in  this  section  is  a  distinct  mass  of , 
yellowish  pigment  displacing  the  other  cell  contents.  In  the  plate 
it  is  of  a  lighter  color  than  the  rest  of  the  cell.  Above  this  in  the 
cell-body  about  the  nucleus,  and  extending  into  the  other  basal 
dendrite,  are  numerous  rounded  and  linear  chromophilic  bodies. 
The  upper  cell  shows  three  dendritic  processes  going  off  from  the 
base  of  the  cell-body  on  the  right  side,  and  two  from  the  left  side. 
These  processes  and  the  large  apical  process  contain  mostly  linear- 
shaped  chromophilic  bodies,  arranged  in  distinct  striae,  parallel  to 


DEMENTIA  PARALYTICA.  6l 

the  contour  of  the  same.  This  arrangement  also  holds  good  at  the 
periphery  of  the  cell-body,  the  strize  there  too  being  parallel  to  the 
contour  of  the  same,  but  about  the  nucleus  the  chromophilic  bodies 
are  so  closely  packed  that  it  is  more  difficult  to  make  out  this  par- 
allel arrangement.  There  is  no  pigmentary  deposit  in  this  cell. 
No  neuroglia  cells  are  to  be  seen  in  this  plate,  the  methylene  blue 
stain  being  used  as  stated  above.  Plate  V.  Fig.  15,  from  the  same 
region  and  under  the  same  magnification,  1,400  diameters,  from 
a  section  ten  microns  in  thickness  and  stained  also  with  methy- 
lene blue,  is  an  exceptionally  fine  photomicrograph  of  one  of  these 


Plate  V,  Fig.  15 

Betz  cells,  inasmuch  as  it  shows  the  processes,  especially  the  apical 
process,  as  far  as  the  edge  of  the  plate.  It  is  usually  difficult  to 
obtain  such  an  extent  of  surface  of  a  cell  in  the  same  plane  under 
such  high  magnification  even  when  the  microtome  cuts  in  exactly 
the  plane  of  the  long  axis  of  the  cell.  These  dendritic  processes 
are  seen  to  be  of  no  mean  size,  especially  the  apical  process  and 
the  chromophiHc  granules  extend  far  up  into  the  same.  Three 
processes  are  seen  given  off  from  the  base,  one  at  each  angle,  and 
the  third  descending  from  the  center.  The  nucleus  is  distinct,  cen- 
trally located,  and  contains  a  large  nucleolus  surrounded  by  an 
irregular   chromatic   network.      The   chromophilic   granules   are 


62  G.  ALFRED  LAWRENCE. 

larger  and  smaller  rounded  and  irregularly  spindle-shaped  granules 
in  the  triangular-shaped  body  of  the  cell,  approaching  to  a  more 
linear  form  in  the  processes.  This  is  a  stichochrome  nerve  cell  of 
the  somatochrome  group. 

Turning  again  to  Plate  III.  Fig.  8,  the  third  layer  will  now 
be  described.  This  is  but  .70  mm.  in  thickness  as  compared  to 
1.20  mm.  for  the  same  layer  in  Plate  II.  Fig.  3.  The  nerve  cells 
in  this  layer  are  similar  in  form  and  structure  to  those  found  in 
the  above  mentioned  plate.  The  neuroglia  cells  are  much  more 
numerous  in  all  the  layers  than  in  Plate  II.  Fig.  3,  due  in  large 
part,  the  writer  believes,  to  the  difference  in  the  staining  method. 
Capillary  vessels,  showing  the  walls  made  up  of  a  single  layer  of 
nucleated  flattened  cells,  are  seen  in  several  places,  especially  in 
the  lower  layer.  Counts  were  made  of  the  nerve  and  neuroglia 
cells  in  different  regions  in  the  manner  previously  described,  using 
the  same  method  and  magnification.  Counts  of  the  nerve  cells  in 
eight  different  fields  from  various  portions  of  the  second  and 
third  layer  were  made,  each  field  containing  thirty-six  squares, 
so  that  288  squares  were  examined.  There  were  found  to  be  an 
average  of  .95  nerve  cells  to  each  square  millimeter  of  the  ocular 
net-micrometer,  which  multiplied  by  100  gives  95  as  the  average 
number  of  nerve  cells  found  to  the  square  millimeter  in  the  second 
and  third  layer  of  the  cortex  in  this  section.  The  first  layer  con- 
tained so  few  scattered  nerve  cells  that  no  field  was  included 
for  this  portion  of  the  cortex,  as  some  fields  here  would  contain  no 
nerve  cells  whatsoever  and  would  thus  greatly  reduce  the  general 
average  where  the  Nissl  stain  is  employed.  On  this  account  the 
nerve  cell  counts  in  this  and  all  subsequent  sections,  as  well  as 
that  of  Plate  II.  Fig.  3,  include  only  the  second  and  third  layers 
of  the  cortex.  The  nerve  cells  are  thus  fewer  in  number  than 
in  Plate  II.  Fig.  3,  but  they  average  larger  in  size,  especially  in 
the  region  of  the  large  pyramidal  and  Betz  cells ;  thus  the  frontal 
convolutions  seem  to  to  contain  more  nerve  cells  than  the  central 
convolutions. 

Neuroglia  cell  counts  were  made  from  three  fields  of  thirty-six 
squares  each  or  108  squares  in  all  from  all  three  layers  of  the  cor- 
tex. The  average  number  of  neuroglia  cells  was  found  to  be  2.93 
for  each  square  millimeter  of  surface  of  the  ocular  net-microme- 
ter, which  multiplied  by  100  gives  293  as  the  average  number  of 
neuroglia  cells  in  each  square  millimeter  of  surface  of  the  cortex 
from  this  section.  The  number  in  each  square  here  varied  from 
none  in  some  squares  to  fourteen  in  one  of  the  squares.  The  next 
highest  number  was  eight,  several  contained  seven,  but  most  of 
them  contained  from  one  to  four.  Counts  were  also  made  from 
a  section  of  the  same  thickness,  ten  microns,  and  from  the  same 
block  as  the  preceding,  but  stained  with  methylene  blue  instead 
of  methylene  violet.     With  this  exception  the  technique  was  ex- 


DEMENTIA  PARALYTICA. 


63 


actly  the  same  in  the  two  preparations.  Counts  were  made  from 
six  different  fields  of  thirty-six  squares  each,  and  the  average 
number  of  nerve  cells  to  each  square  mm.  of  the  ocular  net- 
micrometer  from  various  parts  of  the  second  and  third  layers  was 
.94.  This  result  multiplied  by  100  gives  94  as  the  average  num- 
ber of  nerve  cells  to  each  sq.  mm.  of  surface  of  the  section  as 
compared  to  95  in  Plate  III.  Fig.  8,  a  remarkably  small  difference 
of  only  one  cell  to  each  square  millimeter,  both  counts  being  made, 
the  one  entirely  independent  of  the  other.     Counts  were  made 


N      -- 

^. 

c          ."' 

■i.j.' 

^                     .    ' 

• 

1 

,6 

\     s^ 

Plate  VI,  Fig.  16 

from  seven  different  fields  of  36  sq.  mm.  each  from  various  parts  of 
all  three  layers  of  the  cortex  to  determine  the  average  number  of 
neuroglia  cells.  The  average  number  to  each  square  millimeter 
of  the  ocular  net-micrometer  was  found  to  be  .84,  which  multi- 
plied by  100  gives  84  as  the  average  number  of  neuroglia  cells 
to  each  square  millimeter  of  the  section  as  compared  to  293  in 
Plate  III.  Fig.  8,  where  the  methylene  violet  stain  was  the  stain 
used.  This  further  confirms  the  statement  previously  made  that 
methylene  violet  has  a  greater  affinity  for  these  neuroglia  cells  and 
the  latter  retain  this  dye  much  more  tenaciously  than  they  do  the 
methylene  blue  in  the  subsequent  differentiation,  whereas  the 
nerve  cells  retain  either  dye  about  the  same.    The  same  fact  is  well 


64  G-  ALFRED  LAWRENCE. 

brought  out  in  Plate  IV.  Fig.  12,  and  Plate  V.  Fig.  14,  previously 
described.  In  the  latter  two,  Betz  cells  are  seen  under  a  magnifica- 
tion of  1,400  diameters.  The  stain  used  here  is  methylene  blue, 
and  no  neuroglia  cells  are  to  be  seen.  In  Plate  IV.  Fig.  12,  of 
the  same  magnification,  but  stained  with  methylene  violet,  twelve 
of  these  neuroglia  cells  are  seen  in  the  immediate  vicinity  of  this 
large  Betz  cell.  Sections  were  also  prepared  from  blocks  taken 
from  the  middle  and  lower  thirds  of  this  same  convolution, — the 
anterior  central, — and  it  was  found  that  the  general  type  of 
cortical  lamination  and  histological  structure  remained  the  same. 
Plate  VI.  Fig.  16,  is  a  photomicrograph  of  a  section  taken  from  a 
block  including  the  entire  anterior  central  convolution  for  a  dis- 
tance of  .4  mm.  in  its  lower  third  and  is  representative  of  the 
entire  lower  portion  of  this  convolution.  The  shape  of  the  con- 
volution is  seen  to  have  undergone  considerable  modification  as 
compared  to  the  upper  third,  seen  in  Plate  III.  Fig.  7.  This 
section  is  ten  microns  in  thickness,  fixed  in  alcohol  95  per  cent., 
stained  with  methylene  violet,  the  other  technique  being  similar  to 
previously  described  sections.  The  segment  of  cortex  shown  in 
Plate  VI.  Fig.  17,  under  a  magnification  of  100  diameters,  was 
taken  from  the  point  indicated  by  the  ink  lines  here  and  opposite  a. 
It  is  seen  from  the  mechanical  arrangement  of  the  cortex  to  be 
at  the  most  acute  angle  and  where  the  same  is  thickest.  At  the 
opposite  less  acute  angle  the  cortex  is  not  quite  so  thick,  and  in- 
termediate between  these  angles,  and  also  on  the  anterior  and 
posterior  surfaces  the  cortex  is  still  thinner.  It  will  be  noted 
that  the  depth  of  the  sulcus  anteriorly  at  c  where  it  passes  over 
into  the  third  frontal  convolution  and  is  thus  adjacent  to  the 
motor  speech  area,  is  more  shallow  than  the  posterior  sulcus  or 
fissure  of  Rolando.  The  first  layer  is  irregular  in  depth,  some- 
what thicker  at  the  angle  opposite  a,  and  still  thicker  at  h  and  c, 
whereas  at  the  vertex  it  is  thinner.  The  general  radial  direction 
of  the  cells  from  the  medullary  central  white  substance  to  the  sur- 
face is  fairly  well  seen  here.  In  the  second  layer  the  most  notice- 
able feature  is  the  entire  absence  of  the  Betz  cells  which  are  so 
marked  in  the  upper  portion  of  the  convolution.  Some  very  large 
pyramidal  cells,  intermediate  in  size  to  the  Betz  cells  and  the 
ordinary  larger  pyramidal  cells,  are  to  be  seen  in  this  layer  how- 
ever, as  will  be  noted  in  the  following  (Plate  VI.  Fig.  17)  : 
This  layer  merges  into  the  third  or  irregular  cell  layer,  which 
latter  is  gradually  lost  in  the  white  central  substance  of  the  gyrus. 
At  the  vertex  in  the  cortical  layer  the  section  is  cracked ;  this  be- 
ing an  artefact  resulting  from  manipulation.  The  outer  layer  is 
seen  to  be  also  torn  in  places  from  the  same  cause.  Plate  VI. 
Fig.  17,  is  taken  from  the  strip  indicated  in  ink  in  Plate  VI.  Fig. 
16,  and  is  magnified  100  diameters.  The  first  layer  is  .25  microns 
in  thickness  and   similar  in   structure  to  the  same  layer  in  the 


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Plate  II,  Fig.  3. 


Plate  III,  Fig.  8. 


Plate  VII.  Fig.    ig. 
Plate  XIII,  Fig.  41. 


Plate  Vll,  Fig.  21. 


DEMENTIA  PARALYTICA.  65 

upper  portion  of  the  convolution  already  described.  In  the  second 
layer,  however,  the  greatest  difference  is  found.  The  large, Betz 
cells  practically  disappear  in  the  lower  third  of  this  convolution, 
although  large  pyramidal  cells  simulating  them  in  general  struc- 
ture, but  lacking  the  size,  are  found  in  the  middle  portion  of  this 
layer.  In  this  lower  third  of  the  convolution  the  second  layer  as 
seen  in  this  section  is  1.50  mm.  in  thickness,  and  the  large  pyram- 
idal cells  are  seen  arranged  in  irregular  groups  in  its  middle 
portion.  Below  them  is  seen  a  region  a  averaging  .25  mm.  in 
thickness  in  which  small  pyramidal  cells  are  almost  exclusively 
found.  Below  this  larger  pyramidal  cells  are  seen,  but  not  in  great 
numbers.  The  divison  between  this  and  the  lower  or  spindle  cell 
layer  is  not  well  marked,  the  latter  measuring  .90  mm.  in  thick- 
ness. The  cells  here  are  irregularly  polygonal  or  spindle  shaped 
and  do  not  differ  from  those  in  the  same  region  in  the  upper  part 
of  this  convolution.  The  total  thickness  of  the  cortex  at  this 
point  is  2,65  mm.,  exactly  the  same  as  of  the  section  shown  in 
Plate  III.  Fig.  8.  Counts  of  the  nerve  and  neuroglia  cells  were 
made  in  this  region  in  exactly  the  same  manner  as  in  the  previously 
described  regions.  This  section,  as  above  stated,  is  ten  microns 
in  thickness  and  stained  with  methylene  violet  and  in  seven  fields 
of  36  sq.  mm.  each  from  various  portions  of  the  second  and  third 
layers,  the  average  number  of  nerve  cells  to  each  square  milli- 
meter of  surface  of  the  ocular  net-micrometer  was  found  to  be 
1.08,  multiplied  by  100  gives  108  as  the  average  number  of  nerve 
cells  to  each  square  millimeter  of  surface  of  the  section  in  the 
second  and  third  layer.  The  nerve  cells  in  the  first  layer  were  so 
few  and  scattered  that  no  counts  of  the  same  were  made.  In 
eight  fields  of  36  sq.  mm.  each  from  various  portions  of  the  three 
layers  of  the  cortex  in  this  section  the  average  number  of  neu- 
roglia cells  to  the  square  millimeter  of  surface  of  the  ocular  net- 
micrometer  was  2.48,  multiplied  by  100  gives  248,  as  the  average 
number  of  neuroglia  cells  to  each  square  millimeter  of  surface  of 
the  cortex  of  this  section.  Here  again  it  will  be  seen  that  the 
methylene  violet  stain  shows  a  larger  number  of  neuroglia  cells — 
248,  while  the  nerve  cells — 108,  are  but  slightly  in  excess  of  the 
average  number  in  the  two  previously  described  sections  of  the 
upper  portion  of  the  anterior  central  convolution,  and  slightly  less 
in  number  than  in  the  sections  described  from  the  frontal  con- 
volution (Table  II.). 

Passing  now  to  the  region  posterior  to  this,  we  come  to  the 
posterior  central  convolution  of  this  central  or  motor  region. 
This  posterior  central  convolution  is  regarded  as  a  transition 
region  between  that  anterior  to  the  fissure  of  Rolando,  or  motor 
region,  and  that  posterior  to  the  same  region,  or  sensory  region  of 
those  authors  who  divide  the  cortex  into  a  sensory  and  motor  type 


66  G.  ALFRED  LAWRENCE. 

of  cortical  lamination.  The  first  and  third  layers  here  are  prac- 
tically the  same  as  in  the  region  anterior  to  the  fissure  of  Rolando. 
The  second  layer,  however,  lacks  the  regularity  of  the  correspond- 
ing layer  in  the  above  mentioned  region,  but  as  will  be  seen  in  the 
plate  (Plate  VII.  Fig.  19),  there  is  nothing  new  or  different  in 
this  layer  from  the  corresponding  layer  in  the  plates  already  de- 
scribed. The  large  Betz  cells  seen  only  in  limited  portions  of  the 
region  just  anterior  to  this  and  contained  in  but  a  very  small  por- 
tion of  this  so-called  motor   region   are  replaced   here  by  some 


Plate  VI,  Fig.  18 

smaller  sized,  irregularly  situated  pyramidal  cells,  singly  or  in 
groups,  and  of  similar  internal  structure,  and  mostly  to  be  found 
in  the  middle  and  lower  portion  of  the  layer.  As  typical  of  this 
posterior  central  convolution,  a  section  was  taken  from  a  block 
including  the  middle  portion  of  this  convolution  in  its  entirety  for 
a  distance  of  4  cm.  (5,  Plate  I.  Fig.  i).  The  section  is  6  2-3 
microns  in  thickness,  fixed  in  95  per  cent,  alcohol,  and  stained  with 
methylene  blue,  technique  otherwise  similar  to  all  other  sections. 
Plate  VI.  Fig.  18,  is  a  photomicrograph  of  this  section,  magnified 
14  diameters.   The  convolution  here  presents  a  peculiar  mechanical 


DEMENTIA  PARALYTICA.  6j 

formation,  causing  a  great  variation  in  thickness  of  the  cortex  in 
different  portions,  being  over  twice  as  thick  at  h  as  at  the  point  a, 
from  which  latter  point  Plate  VII.  Fig,  19  was  taken.  This  condi- 
tion is  not  an  artefact,  as  under  high  magnification  no  indication 
of  disturbance  of  the  relations  of  the  cells  is  to  be  observed.  At 
the  vertex,  however,  there  is  an  artificial  break  in  the  first  and 
upper  part  of  the  second  layer  at  two  points.  The  first  layer  is 
seen  to  vary  in  thickness,  being  thicker  at  the  acute  angle  below  h, 
and  gradually  becoming  thinner  as  it  approaches  the  vertex,  to 
become  again  thicker  below  a.  The  general  radial  direction  of 
the  cells  is  well  seen,  especially  at  the  vertex  and  anterior  aspect, 
as  at  a.  Ar  h  it  is  not  quite  so  well  made  out,  but  exists  to  a  fairly 
well  marked  degree  when  examined  under  a  higher  power. 
Pyramidal  cells  of  considerable  size  are  seen  in  some  parts  of  this 
layer,  more  especially  in  the  middle  portion,  but  in  no  case  do 
they  approach  in  size  to  the  Betz  cells,  nor  are  they  for  the  most 
part  situated  in  the  same  portion  of  the  cortex.  The  third  layer 
is  thin  and  soon  lost  to  view  in  the  medullary  white  substance. 
Plate  VII.  Fig.  19,  is  a  photomicrograph  of  the  strip  a  enclosed  in 
ink  lines  in  Plate  VI.  Fig.  18,  and  magnified  100  diameters.  The 
first  or  upper  layer  at  this  point  is  somewhat  irregular  in  contour 
and  averages  .20  mm.  in  thickness.  It  contains  neuroglia  cells 
and  some  scattered  nerve  cells  similar  in  appearance  and  structure 
to  those  described  in  Plate  II.  Fi.  3,  for  the  same  region.  The 
second  or  pyramidal  cell  layer  is  especially  interesting,  owing  to  the 
irregularity  of  the  distribution  of  its  cells.  At  the  upper  portion 
the  small  pyramidal  cells  are  seen  closely  aggregated  together. 
Below  this  these  cells  become  more  scattered,  and  irregularly  in- 
terspersed among  them  are  medium  sized  and  larger  pyramidal 
cells.  Some  of  the  larger  of  these  have  a  tendency  to  be  ar- 
ranged singly  or  in  groups  and  have  an  internal  structure  similar 
to  the  giant  pyramidal  or  Betz  cells  found  in  parts  of  the  anterior 
central  convolution  and  in  the  posterior  part  of  the  first  frontal 
convolution.  The  chromophilic  granules  are,  however,  of  smaller 
size  though  similarly  arranged  in  some  of  the  cells.  About  the 
middle  of  this  layer,  opposite  a,  is  seen  another  region  in  which 
the  small  pyramidal  cells  predominate,  and  in  which  there  are 
scarcely  any  larger  pyramidal  cells.  Just  below  this  again  are 
seen  large  pyramidal  cells  arranged  singly  and  in  groups,  forming 
the  lower  portion  of  this  second  layer  which  measures  about  1.45 
mm.  in  thickness  and  below  gradually  merging  into  the  third  or 
spindle  cell  layer.  In  addition  to  the  spindle  cells  there  are  many 
irregular  polygonal  cells  founds  in  this  layer  which  at  this  point 
is  about  .60  mm.  in  thickness  and  only  partially  shown  in  the 
plate ;  the  upper  two-thirds  being  seen  here.  The  lower  third,  not 
shown,  is  similar  and  gradually  merges  into  the  white  medullary 


68  G.  ALFRED  LAWRENCE: 

substance.  The  entire  cortex  is  thus  2.25  mm.  in  thickness  at  this 
point,  whereas,  as  above  mentioned  at  point  b  in  Plate  VI.  Fig.  18, 
it  is  over  5  mm.  in  thickness.  Taking  into  consideration  the  varia- 
tions found  in  different  parts  of  the  same  area,  often  quite  near 
together,  and  considering  the  general  type  of  arrangements,  it 
does  not  seem  to  the  writer  that  this  area  varies  to  a  very  marked 
degree  from  the  general  type,  or  at  least  to  such  an  extent  as  to  be 
especially  marked  off  from  the  other  regions  of  the  cortex.  There 
is  certainly  a  greater  variation  between  dift'erent  regions  of  the 
anterior  central  convolution  as  in  the  upper  and  lower  portions, 
where  some  parts  have  no  Betz  cells  and  others  have  thern  vari- 
ously distributed,  as  well  as  other  differences,  than  between  this 
region  and  the  frontal  region  as  a  whole.  Those  who  separate  the 
cortex  into  two  types, — an  anterior  or  motor  type,  and  a  posterior 
or  sensory  type, — regard  this  convolution  as  the  transition  region 
between  the  two.  An  examination  of  sections,  both  anterior  and 
posterior  to  this  convolution,  shows  that  the  same  general  plan  of 
arrangement  is  carried  out  in  all  parts  of  the  external  surface  of 
the  cortex  with  only  miiior  differences  which  do  not  seem  sufficient 
to  make  such  a  marked  distinction  applicable  anatomically,  and 
certainly  not  histologically.  The  size  and  form  of  the  cells  and 
their  general  arrangement  differs  but  slightly  from  that  of  the 
region  anterior  and  posterior,  with  the  exception  of  the  Betz  cell 
groupings  in  localized  portions  of  the  former. 

Nerve  cell  and  neuroglia  cell  counts  were  m'ade  with  the  ocular 
net-micrometer  here  in  this  region  in  the  same  manner  as  in  the 
other  previously  described  sections.  Eight  fields  of  thirty-six 
square  millimeters  each,  from  various  portions  of  the  second  and 
third  layers  of  the  cortex,  were  examined  and  185.5  nerve  cells 
were  found  to  be  the  average  number  for  each  square  millimeter 
of  surface  of  the  section.  In  the  same  manner  the  neuroglia  cells 
were  counted  in  eight  fields  from  all  three  layers  of  the  cortex 
and  109.2  neuroglia  cells  were  found  to  be  the  average  number  for 
each  square  millimeter  of  surface  of  the  section  in  the  cortex. 
Here  methylene  blue  was  the  stain  employed  with  the  resulting  low 
average  number  of  neuroglia  cells,  whereas  the  average  number 
of  nerve  cells  is  found  to  be  higher  than  in  any  of  the  previously 
described  sections  anterior  to  this  region,  and  it  will  be  seen  sub- 
sequently that  it  is  also  higher  than  that  found  for  the  region 
posterior  as  well  although  the  section  is  6  2-3  microns  in  thick- 
ness, and  some  already  described  are  10  microns  in  thickness 
(Table  II.).  This,  however,  bears  out  the  statement  previously 
made  that  sections  between  six  and  ten  microns  in  thickness  con- 
tain practically  all  nerve  cells  that  can  be  seen  in  one  plane. 

Parietal  Region. — Posterior  to  the  region  just  described  we 
come  to  the  parietal   region,  made  up  of  the  superior  parietal, 


DEMENTIA  PARALYTICA. 


69 


supra-inarginal,  and  supra-angular  convolutions.  The  general 
arrangement  of  the  layering  of  the  cortex  is  fairly  uniform 
throughout  this  region  and  the  section  represented  in  Plate  VII, 
Fig.  20.  from  a  block  taken  from  the  supra-marginal  convolu- 
tion is  typical  of  this  region  (7,  Plate  I.  Fig.  i).  The  block  was 
fixed  in  Van  Gehuchten's  fluid,  stained  with  methylene  violet,  and 
other  technique  as  for  previous  regions.  The  actual  size  of  this 
section  is  7  mm.  in  its  greatest  width,  and  8  mm.  in  length,  and  it 
is  6  2-3  microns  in  thickness.     As  seen  in  the  photomicograph, 


c. 

A 

.^ 

\               ■ 

/ 

/ 

<9 

p     ■ 

\ 

\  ■ 

,4 

Plate  VII,  Fig.  20 


magnified  14  diameters,  the  convolution  is  wider  above  at  the 
surface  than  deeper  down  in  the  sulcus.  At  the  point  a  is  seen 
the  position  of  the  strip  from  which  the  photomicograph  repre- 
sented in  Plate  VII,  Fig.  21  was  taken.  At  h  and  c,  owing  to  the 
greater  angle,  the  cortex  is  considerably  thicker  than  at  a.  The 
shape  of  the  convolution  here  is  seen  to  be  different  again  from 
any  of  the  preceding,  thus  giving  a  somewhat  different  mechanical 
arrangement,  with  a  broad  flattened  vertex  and  shorter  anterior 


70  G.  ALFRED  LAWRENCE.. 

and  posterior  aspects.  At  the  lower  portion,  on  the  right,  a  part 
of  the  cortex  was  cut  away  in  removing  the  block.  In  the  vicin- 
ity of  a  there  are  some  minute  artefacts,  causing  an  irregularity 
of  the  surface  here,  and  small  fragments  are  partially  torn  away 
at  two  points.  The  first,  or  superficial  layer,  is  fairly  uniform  in 
thickness,  excepting  opposite  a,  which  will  be  discussed  more 
fully  in  describing  the  next  plate  (Plate  VII,  Fig.  21),  and  upon 
the  posterior  and  anterior  aspects,  where  this  layer  is  slightly 
thicker.  The  radial  arrangement  of  the  cells  of  the  second  layer 
is  well  shown,  and  the  cortex  is  seen  to  be  thicker  at  the  angles 
b  and  c,  as  before  mentioned.  Throughout  the  middle  and  lower 
part  of  this  layer  well  developed  pyramidal  cells  are  seen,  some 
almost  approaching  in  type  small  Betz  cells.  The  third  layer  pre- 
sents nothing  unusual,  and  gradually  passes  over  into  the  white 
medullary  substance.  Plate  VII,  Fig.  21,  shows  the  strip  indi- 
cated in  ink  opposite  a  in  Plate  VII,  Fig.  20,  under  a  magnifica- 
tion of  100  diameters.  The  first  or  superficial  layer  is  seen  to  be 
irregular  at  this  point,  about  20  mm.  in  thickness  at  the  right  of 
the  plate,  then  increasing  rather  suddenly  to  .25  mm.  for  a  short 
distance,  when  the  outline  suddenly  descends,  decreasing  the 
layer  at  this  point  to  .15  mm.  It  then  gradually  increases  until, 
at  the  left  of  the  plate,  it  is  .22  mm.  in  thickness.  The  extreme 
thickness  near  the  center,  although  the  surface  is  only  slightly 
torn  at  several  points  and  scarcely  noticeable,  yet  has  the  appear- 
ance of  an  artefact,  due  no  doubt  to  the  unequal  pressure  in  the 
manipulation  of  removal,  when  the  brain  was  in  its  natural  soft 
condition,  prior  to  any  post-mortem  changes.  A  short  distance 
below  the  surface  at  this  point  the  cortical  substance  itself  is  seen 
slightly  broken,  thus  confirming  the  artificial  nature  of  the  irregu- 
larity and  increase  in  depth.  The  nerve  and  neuroglia  cells  are 
similar  to  those  found  in  this  layer  in  the  regions  anterior  to  this. 
The  second  or  pyramidal  cell  layer  is  1.60  mm.  in  thickness,  and 
contains  small  pyramidal  cells  exclusively  in  the  upper  portion. 
Very  soon,  however,  larger  pyramidal  cells  appear,  and  at  about 
the  middle  of  the  layer  are  the  greatest  in  size  and  most  numerous 
of  the  layer.  Some  of  these  large  pyramidal  cells  in  point  of  size 
and  structure  appear  intermediate  between  the  large  and  giant 
pyramidal  or  Betz  cells.  They  also  tend  to  be  arranged  singly  or 
in  groups,  with  smaller  cells  about  them.  Just  below  the  middle 
of  this  layer,  at  a,  is  found  a  region  .20  mm.  in  thickness,  con- 
spicuous by  the  almost  entire  absence  of  large  pyramidal  cells, 
and  made  up  for  the  most  part  of  small  pyramidal  cells.  Below 
this  large  pyramidal  cells  again  appear,  intermingled  with  the 
small  pyramidal  cells,  and  the  layer  gradually  passes  over  into  the 
lower  or  spindle-cell  layer.  The  pyramidal  cells  have  the  same 
internal  structure  as  those  in  the  region  anterior  to  this,  in  the 


DEMENTIA  PARALYTICA.  71 

lars^est  ones  the  chromophilic  granules  simply  being  larger  and 
more  conspicuous ;  thus  these  cells  come  under  the  same  classifi- 
cation, according  to  Nissl,  as  those  in  the  frontal  and  central  con- 
volutions. The  third  or  spindle-cell  layer  is  .70  mm.  in  thickrress, 
and  not  distinctly  separated  from  the  layer  above.  The  arrange- 
ment of  the  cells  and  their  form  and  size,  as  well  as  the  internal 
structure,  is  in  no  way  ditterent  from  the  corresponding  layer  in 
the  cortex  anterior  to  this.  The  total  thickness  of  the  cortex  here 
is  then  2.50  mm.,  being  .25  of  a  mm.  thicker  than  in  the  section 
of  the  posterior  central  convolution  previously  described,  .15  mm. 
less  in  thickness  than  the  section  shown  in  Plate  III.  Fig.  8,  from 
the  anterior  central  convolution,  and  .35  mm.  less  than  in  the  sec- 
tion of  the  first  frontal  convolution  shown  in  Plate  II,  Fig.  3. 
The  variation  in  thickness  is  thus  seen  to  be  slight  and  no  greater. 
and  even  not  so  great  as  can  be  found  in  contiguous  portions  of 
any  one  convolution.  In  other  parts  of  the  parietal  region  the 
arrangement  of  the  cortical  lamination  is  similar  to  that  de- 
scribed above  with  minor  modifications,  due  to  differences  in 
shape,  etc.,  of  the  convolutions.  Here  nerve  cell  and  neuroglia 
cell  counts  were  made  in  the  same  manner  as  in  previous  regions, 
and  the  average  number  of  nerve  cells  to  the  square  millimeter  of 
surface  of  the  section  was  found  to  be  104,  w^hereas  the  average 
number  of  neuroglia  cells  for  the  same  area  of  surface  of  the  sec- 
tion w'as  180.90.  This  is  the  lowest  average  of  nerve  cells  in  any 
region  of  this,  brain,  with  the  exception  of  the  upper  portion  of 
the  anterior  central  convolution.  The  methylene  violet  stain 
makes  the  average  number  of  neuroglia  cells  quite  high,  however, 
though  considerably  less  than  in  the  upper  portion  of  the  anterior 
central  convolution. 

Temporal  Region. — Below  the  parietal  region  just  discussed 
W'C  come  to  the  three  temporal  convolutions — the  first,  second  and 
third.  Here  the  general  arrangement  of  the  cortical  laminations 
and  the  cell  structure  is  practically  the  same  in  the  three  convolu- 
tions, and  bears  a  striking  resemblance  to  that  found  in  the  frontal 
region.  A  block  was.  taken  from  the  anterior  portion  of  the  first 
temporal  convolution  near  the  apex  (6,  Plate  I,  Fig.  i),  the  entire 
width  of  the  convolution  and  for  a  distance  of  .4  cm.  The  actual 
size  of  the  section  from  this  block  represented  in  the  photomicro- 
graph r Plate  A'll.  Fig.  22)  is  8.5  mm.  at  the  wddest  point,  and 
8.5  mm.  in  length  on  the  right,  and  6  mm.  in  length  on  the  left, 
and  it  is  6  2-3  microns  in  thickness.  The  block  was  fixed  in  Van 
Gehuchten's  fluid,  stained  w'ith  meth}lene  blue,  all  the  other 
details  of  technique  being  similar  to  that  employed  for  previously 
described  sections.  This  photomicrograph  is  magnified  14  diam- 
eters, and  here  the  shape  of  the  gyrus  is  seen  to  be  somewhat 
similar  to  that  in  Plate  Yll,  Fig  20,  but  broader  above,  and  also 


72 


G.  ALFRED  LAWRENCE. 


with  a  broader  base.  The  vertex  is  flattened  similarly,  resulting 
in  the  more  acute  anglg  at  b  and  the  slightly  obtuse  angle  at  c, 
at  which  points  the  cortex  is  thicker  than  at  the  vertex  or  the 
anterior  or  posterior  aspects.  The  cortex  is  seen  to  be  uniformly 
thicker  along  the  surface,  opposite  d,  than  upon  the  opposite 
aspect  at  and  above  and  below  a.  The  first  or  superficial  layer  is 
thicker  at  c  than  in  other  portions,  and  is  somewhat  b'-oken  in 
places  along  the  vertex.  The  second  layer  varying  in  thickness, 
being  thickest  at  the  points  mentioned  above,   where   the   entire 


G 

\ 

b     ■ 

D 

■\ 

'4 

■^ 

•  t 

* 

Plate  VII,  Fig.  22 


cortex  is  thickest,  shows  the  radial  arrangement  of  the  cells  very 
well,  especially  at  the  vertex  and  opposite  a  and  b.  The  larger 
nerve  cells  appear  quite  conspicuous  in  the  middle  and  lower  por- 
tion of  this  layer  in  places.  The  third  layer  is  quite  uniform,  dis- 
appearing in  the  white  medullary  central  substance.  Plate  VIII, 
Fig.  23,  shows  the  strip  a  of  Plate  VIII,  Fig.  22  at  a  magnification 
of  100  diameters.  Here  the  dififerentiation  has  been  carried  to 
about  the  same  stage  as  in  Plate  II,  Fig.  3,  and  the  paucity  of 
neuroglia  cells  is  equally  as  apparent.    Again  the  general  arrange- 


DEMENTIA  PARALYTICA.  73 

nient  of  the  cells  in  the  two  plates  is  remarkably  similar.  The 
first  or  superficial  layer  is  here  .25  mm.  in  thickness,  and  contains, 
for  the  most  part,  neuroglia  cells  and  a  few  scattered  nerve  cells. 
The  second  or  pyramidal  cell. layer  measures  1.65  mm.  in  thick- 
ness, as  compared  to  1.40  mm.  in  Plate  II,  Fig  3,  being  thus 
slightly  thicker  than  in  the  latter.  The  cells  are  arranged  prac- 
tically the  same,  however,  the  small  pyramidal  cells  above  inter- 
mingled with  larger  pyramidal  cells  in  increasing  numbers  deeper 
down  in  the  layer.  Here  again,  at  a  point  somewhat  deeper  than 
in  Plate  II,  Fig".  3.  is  to  be  found  a  region  at  a,  of  the  same  thick- 
ness— .30  mm.,  where  small  pyramidal  cells  arc  found  almost  ex- 
clusively, followed  again  by  a  region  containing  large  pyramidal 
cells  in  considerable  numbers  in  addition  to  small  pyramidal  cells. 
This  layer  finally  passes  over  into  a  narrow  (.40  mm.  thick)  third 
or  spindle-cell  layer.  This  layer  is  also  similar  to  that  of  Plate 
II,  Fig.  3,  with  the  exception  of  its  depth,  the  latter  having  a 
spindle  or  irregular  cell  layer,  measuring  1.20  mm.  in  thickness. 
As  will  be  seen  by  referring  to  Plate  I,  Fig.  2,  the  strip  a  repre- 
sented in  Plate  II,  Fig.  3,  was  taken  from  the  point  of  greatest 
curvature,  where  the  cortex  is  usually  the  thickest,  whereas  Plate 
VIII,  Fig.  23,  was  taken  from  the  point  a  shown  in  Plate  VIII, 
Fig.  22,  from  the  side  of  the  section  where  the  cortex  is  thinner. 
The  entire  depth  of  the  cortex  is  found  to  be  2.30  mm.,  as  com- 
pared to  2.85  mm.  in  Plate  II,  Fig.  3,  a  difference  of  .55  mm. 
There  are  no  larger  pyramidal  cells  here  intermediate  in  size  be- 
tween the  Betz  cells  and  the  ordinary  large  pyramidal  cells,  as  were 
noted  singly  or  in  small  groups  scattered  in  the  central  and  parie- 
tal convolutions  already  described,  and,  as  we  shall  see,  also  occur 
in  the  occipital  convolution.  The  internal  structure  of  these  cells 
and  their  classification  are  similar  to  that  for  the  cells  described  in 
Plate  II,  Fig.  3.  Nerve  and  neuroglia  cell  counts  were  made 
from  this  section,  which,  as  above  mentioned,  is  6  2-3  microns  in 
thickness  and  stained  with  methylene  blue.  Seven  fields  of  36 
sq.  mm.  each  gave  an  average  of  146  nerve  cells  to  each  square 
millimeter  of  surface  of  the  section,  and  eight  fields  of  the  same 
size  gave  an  average  of  131.90  neuroglia  cells  to  each  square  milli- 
meter of  surface  of  the  section.  It  will  be  seen  upon  comparing 
these  figures  with  those  from  sections  of  regions  more  anterior 
and  above,  that  they  show  a  larger  number  of  nerve  cells  than  in 
the  sections  from  the  regions  anterior  to  the  fissure  of  Rolando, 
but  a,  less  number  than  that  for  the  posterior  central  convolution, 
and  more  than  from  the  parietal  region.  The  neuroglia  cells  are 
about  the  same  in  number  as  in  Plate  II,  Fig.  3  of  the  frontal 
region. 

"  Occipital  Region. — Coming  to  the  posterior  pole  of  the  ex- 
ternal cortex,  the  typical  structure  of  the  occipital  lobe  is  repre- 


74-  G.  ALFRED  LAWRENCE. 

sented  by  Plate  VTII,  Fig.  24,  a  section  magnified  14  diameters 
from  a  block  taken  from  the  point  indicated  by  the  figure  8,  Plate 
I,  Fig.  I.  The  section  is  6  2-3  microns  in  thickness,  is  6  mm.  in 
width  at  the  widest  portion,  and  7  m.m.  in  length,  stained  with 
methylene  violet,  fixed  in  Van  Gehuchten's  fluid,  other  technique 
as  previously  described.  This  convolution  is  seen  to  be  quite  dif- 
ferent in  shape  from  the  two  previously  described  of  the  temporal 
and  parietal  regions,  having  a  broader  base  and  narrower  rounded 
vertex.  The  cortex  is  seen  to  be  thickest  on  the  lateral  aspect  b, 
thinner  on  the  opposite  lateral  aspect  c,  and  thinnest  at  the  vertex 
in  the  vicinity  of  a;  the  central  white  medullary  substance  being 
reduced  to  a  minimum.  The  outer  layer  varies  in  thickness,  being 
thickest  at  c.  Above  this  it  is  broken  away  for  a  short  distance, 
is  quite  thin  at  the  vertex,  and  becomes  somewhat  thicker  on  the 
lateral  aspect  b.  Above  b  the  section  is  seen  to  be  cracked,  an 
artefact  resulting  from  its  fixation  upon  the  slide,  also  at  c  numer- 
ous small  breaks  are  noticed,  due  to  the  microtome  knife.  Oppo- 
site a,  and  enclosed  in  ink  lines,  is  the  segment  of  this  section, 
represented  in  Plate  IX,  Fig.  25,  under  a  magnification  of  100 
diameters.  The  radial  arrangement  of  the  cells  is  well  made  out 
at  the  vertex,  but  not  quite  so  readily  seen  on  the  lateral  aspects 
of  the  gyrus  here,  but  under  a  higher  magnification  can  be  dis- 
tinctly made  out.  About  the  middle  of  the  second  layer,  especially 
at  the  vertex,  some  very  large  pyramidal  cells  are  to  be  seen 
singly  or  in  groups,  and  approaching  the  Betz  cells  in  type  in 
some  cases.  The  third  or  lower  layer  presents  nothing  unusual, 
and  disappears  below  into  the  white  medullary  substance  of  the 
interior  of  the  gyrus.  Plate  IX,  Fig.  25,  is  a  photomicrograph  of 
the  segment  a,  enclosed  in  ink  lines  in  Plate  VIII,  Fig.  24,  at  a 
magnification  of  100  diameters.  Here  the  cortex  is  found  thinner 
than  in  any  of  the  preceding  plates,  measuring  scarce  2  mm.  in 
thickness.  The  first  layer  averages  only  .15  mm.  in  thickness,  and 
in  structure  and  arrangement  of  the  cells  is  similar  to  this  layer  in 
the  preceding  plates.  The  second  layer  measures  1.15  mm.  in 
thickness,  containing  small  pyramidal  cells  above  and  quite  closely 
packed  together,  but  increasing  in  size  below  and  being  somewhat 
more  scattered.  About  the  middle  of  this  layer  a  number  of  large 
cells  are  seen,  many  singly,  but  some  arranged  in  groups  in  places. 
Some  of  these  are  even  larger  than  those  found  in  the  parietal 
convolution,  and  are  intermediate  in  size  between  the  Betz  or 
giant  pyramidal  cells  and  the  large  pyramidal  cells.  These  latter 
are  not  very  numerous  in  this  region,  the  small  pyramidal  cells 
making  up  by  far  the  greatest  part  of  the  cellular  elements  of  this 
layer.  Below  the  middle  of  this  layer  is  to  be  found  a  region,  at  a, 
almost  exclusively  made  up  of  small  pyramidal  cells  about  .25 
mm.  in  width.     Between  this  and  the  lower  border  large  pyram- 


DEMENTIA  PARALYTICA. 


75 


idal  cells  are  again  found  intermingled  with  the  smaller.  The 
third  or  spindle  cell  layer  is  here  .70  mm.  in  thickness,  containing 
larger  and  smaller  spindle  and  irregularly  polygonal  cells,  the 
lower  border  being  gradually  lost  in  the  white  medullary  sub- 
stance below.  The  nerve  cells  are  found  quite  numerous  and 
closely  aggregated  in  this  region,  as  counts  by  the  same  method 


Plate  VIII,  Fig.  24. 


and  manner  as  in  all  previous  sections,  give  here  an  average  of 
164  nerve  cells  to  the  square  millimeter  of  surface  of  the  section, 
and  199  neuroglia  cells,  the  section  being  6  2-3  microns  in  thick- 
ness and  stained  with  methylene  violet.  The  cells  are  thus  seen 
to  be  more  numerous  than  in  any  other  region  of  the  external 
surface  of  the  hemisphere,  with  the  exception  of  the  posterior  cen- 
tral convolution.  The  fact  of  the  greater  number  of  the  pyramidal 


76 


G.  ALFRED  LAWRENCE. 


cells  being-  small,  permits  of  their  closer  aggregation,  and  no  doubt 
is  an  important  factor  in  the  result  of  the  nerve  cell  counts.  The 
number  of  neuroglia  cells  averages  higher  than  in  any  other 
region  posterior  to  the  fissure  of  Rolando,  but  they  are  less  in 
number  than  in  the  anterior  central  convolution. 

This  includes  the  plates  of  the  external  surface  of  the  cortex, 
but  for  the  purpose  of  comparison,  several  plates  will  be  intro- 
duced from  other  parts  of  the  central  nervous  system.  The  first 
of  these  is  a  photomicrograph,  Plate  IX,  Fig.  26,  of  several  large 


Plate  IX,  Fig.  27. 


pyramidal  cells  from  the  layer  of  large  pyramidal  cells  of  the 
hippocampus  major  or  cornu  ammonis;  between  the  alveus,  repre- 
senting the  white  medullary  substance  of  the  ordinary  gyrus,  and 
the  stratum  radiatum  containing  the  apical  dendrite  processes  of 
these  hippocampal  pyramidal  cells.  This  plate  and  the  two  follow- 
ing are  not  presented  as  a  basis  of  comparison  with  similar 
regions  of  the  pathological  brain  subsequently  to  be  described, 
but  to  give  an  idea  of  the  appearance  of  these  cells  in  a  normal 
brain  as  seen  in  a  photomicograph  of  a  Nissl  preparation  magni- 


DEMENTIA  PARALYTICA. 


11 


fied  1,400  diameters,  as  distinct  types  in  Xissl's  classification. 
These  large  cells  of  the  cornu  ammonis  are  given  as  one  of  the 
four  types  of  Group  II  of  the  stichochrome  nerve  cells  in  his 
classification ;  the  other  three  types  being  ( i )  the  nerve  cells  of 
the  motor  nuclei,  (2)  certain  cells  of  the  cerebral  cortex,  and 
(3)  certain  cells  of  the  spinal  ganglia.     In  shape  these  cells  ap- 


Plate  IX,  Fiff.  26. 


proach  the  larger  pyramidal  cells  of  the  external  surface  of  the 
cortex,  second  layer,  but  are  somewhat  more  slender,  of  a  narrow 
pyramidal  shape,  have  fewer  basal  dendritic  processes,  and  a  long, 
somewhat  slender,  apical  dendritic  process.  The  chromatic  sub- 
stance here  is  made  up  of  very  small  granules  fusing  into  larger 


78  G.  ALFRED  LAWRENCE. 

and  smaller  masses  in  places,  so  that  in  the  photomicrograph  it  is 
difficult  to  differentiate  and  determine  their  arrangement  accu- 
rately. In  some  of  the  cells,  as  in  the  cell  to  the  extreme  right  of 
the  plate,  and  partially  out  of  the  field,  the  rounded  and  linear 
granules  above  the  nucleus,  and  extending  into  the  apical  process, 
are  seen  to  have  a  general  parallel  arrangement.  The  nuclei  of 
these  cells  are  large,  and  contain  a  large,  well  marked  nucleolus 
and  a  more  or  less  irregular  chromatic  network.  As  this  section 
was  stained  with  methylene  violet,  numerous  neuroglia  cells  are 
distinctly  seen  scattered  among  the  pyramidal  nerve  cells. 

From  the  cerebellar  cortex  a  photomicrograph  was  taken  of 
two  Purkinje  cells,  magnified  1,400  diameters,  and  shown  in  Plate 
IX,  Fig.  27.  The  section  from  which  this  photomicrograph  was 
taken  was  situated  on  the  external  surface  of  the  left  hemisphere, 
cut  transversely  to  the  horizontal  axis  of  the  same,  fixed  in  alcohol 
95  per  cent,  stained  with  methylene  blue :  other  technique  similar 
to  that  of  previously  described  plates.  The  section  is  10  microns 
in  thickness.  These  Purkinje  cells  were  given  by  Nissl  as  typical 
examples  of  what  he  formerly  described  as  Group  II,  arkyosti- 
chochrome  nerve  cells  of  the  somatochrome  class,  in  which  was 
presented  a  striated  appearance,  with  a  network-like  structure, 
united  in  a  most  intricate  manner,  thus  having  characteristics  of 
both  the  arkychrome  and  the  stichochrome  cells.  He  now  classi- 
fies them  as  one  of  the  types  of  Group  I,  the  arkyochrome  nerve 
cells.  In  the  Purkinje  cell,  to  the  right,  the  base  of  each  of  the 
two  large  dendritic  processes  is  seen,  one  going  off  to  the  right, 
the  other  to  the  left,  subsequently  to  divide  and  subdivide  in  the 
internal  layer,  not  shown  in  the  plate.  The  Purkinje  cell  10  the 
left  shows  only  one  of  these  processes  in  this  plane,  that  going 
off  to  the  left  which  divides  in  the  same  manner  as  above  de- 
scribed for  the  other  cell.  The  large  rounded  nucleus,  with  its 
centrally  placed  nucleolus,  is  fairly  well  shown  in  the  cell  to  the 
right,  and  contains  a  fine  network  of  chromatic  substance.  The 
chromatic  substance  of  the  body  of  the  cell  is  made  up  of  larger 
and  smaller  irregularly-rounded  chromophilic  bodies,  arranged  in 
an  indefinite  network  extending  up  into  the  base  of  the  dendritic 
processes.  A  nuclear  cap  is  seen  above  the  nucleus  of  the  Pur- 
kinje cell  on  the  right.  The  closely-packed  fine  granular  cells  of 
the  granular  layer  of  the  cerebellum  are  seen  just  below  these  two 
Purkinje  cells,  and  are  included  in  the  class  of  cytochrome  nerve 
cells  in  Nissl's  classification.  They  contain  a  nucleus  almost 
filling  the  cell  body,  and  which  is  surrounded  by  only  a  very  nar- 
row rim  of  chromatic  substance.  Within  the  nucleus  is  a  nucleo- 
lus, and  in  some  of  these  nuclei  several  irregularly-arranged  chro- 
matic granules  are  also  seen.  Between  the  Purkinje  cells  is  a 
small  nerve  cell  with  rounded  body  and  an  apical  dendritic  pro- 


DEMENTIA  PARALYTICA. 


79 


cess.     It  contains   a  nucleus,   nucleolus,   and   some   chromophilic 
granules  irregularly  arranged  in  the  cell-body. 

The  last  photomicrograph  in  the  series  of  the  normal  histo- 
logical material  is  that  shown  in  Plate  X,  Fig.  28.  of  a  typical 
multipolar  ganglion  cell  from  the  anterior  horn  of  the  lumbar 
enlargement  of  the  spinal  cord,  under  a  magnification  of   1,400 


Plate  X,  Fig.  28. 


diameters.  The  segment  of  cord  from  which  the  section  was 
taken  was  fixed  in  Van  Gehuchten's  fluid;  this  section  is  6  2-3 
microns  in  thickness  and  stained  with  methylene  violet.  This  cell 
is,  according  to  Nissl's  classification,  an  arkyochrome  nerve  cell, 
Group  I,  of  the  somatochrome  class,  the  chromophilic  bodies  being 


bo  G.  ALFRED  LAWRENCE. 

arranged  more  in  the.  form  of  a  network  than  in  a  parallel  ar- 
rangement in  the  cell-body,  though  within  the  dendritic  processes 
these  bodies  are  more  or  less  distinctly  parallel  in  arrangement. 
The  cell -body  is  irregularly  polygonal  in  outline,  with  five  large 
dendritic  processes  going  off  in  different  directions,  and  contain- 
ing at  the  base,  and  for  a  considerable  distance,  linear-shaped 
chromophilic  bodies,  arranged  in  a  more  or  less  parallel  niaririer 
and  spreading  out  and  connected  with  the  cell-body  network.  This 
latter  is  made  up  of  irregularly-rounded  and  elongated  chromo- 
philic bodies,  arranged  in  an  irregular  network.  The  nucleus  is 
large,  rounded,  slightly  eccentric  in  situation,  and  contains  a  large 
rounded  nucleolus  and  a  pale  indefinite  network  of  chromatic 
substance.  Numerous  neuroglia  cells  are  seen  scattered  about, 
singly  or  in  groups,  in  the  immediate  vicinity  of  this  cell.  Part  of 
another  large  ganglion  cell  is  seen  at  the  upper  portion  of  the 
plate,  on  the  left. 

This  concludes  the  very  brief  discussion  of  the  cortex  of  the 
normal  brain,  in  which  an  endeavor  has  been  made  to  present 
typical  sections  of  the  main  divisions  of  the  external  surface  of 
the  cerebral  hemisphere  by  means  of  photomicrography,  upon 
which  the  greatest  care  was  employed,  in  order  to  give  an  accurate 
idea  of  the  usual  appearance  to  be  seen  under  the  microscope  in 
the  study  of  such  sections  in  contradistinction  to  the  common 
diagrammatic  figures  that  one  usually  associates  with  such  work, 
and  which  do  not  show  the  actual  arrangement  and  structure,  but 
rather  the  ideal  or  embodyment  in  one  figure  of  what  is  to  be 
found  in  parts  of  many.  The  writer,  on  the  other  hand,  does  not 
wish  to  be  understood  as  not  favoring  diagrammatic  or  schematic 
figures  in  work  of  this  kind,  as  he  regards  them  as  highly  im- 
portant and  a  valuable  accessory  to  photomicrography  and  accu- 
rate drawings  in  the  proper  conception  of  the  intricate  structure 
and  arrangement  of  the  various  portions  of  the  nervous  system 
as  well  as  other  systems.  That  there  are  minor  variations  from 
these  plates  in  the  dififerent  regions  has  been  repeatedly  stated, 
but  the  variation  is  only  a  minor  one,  and  does  not  depart  suffi- 
ciently from  the  type  to  be  considered  as  more  than  a  modifica- 
tion. Furthermore,  in  going  over  the  various  plates  from  the 
different  regions  it  will  be  seen  that  there  is  a  general  uniformity 
of  arrangement  and  structure  of  the  cells,  and  that  one  region 
does  not  vary  to  any  great  extent  from  that  of  any  other  region. 
This  is  well  illustrated  by  comparing  the  plates  from  the  frontal 
region  with  those  of  the  temporal  region,  in  which  it  would  be 
difficult  to  determine  the  one  from  the  other.  The  Betz  cells  in 
parts  of  the  motor  cortex  are  a  conspicuous  modification,  but 
when  we  consider  that  only  a  small  part  of  the  motor  area  con- 
tains these  cells,  and  again  that  these  cells,  though  large,  represent 


Plate  IX,  Fig.  25.  Plate  XI,  Fig.  31. 


Plate  XI.  Fig.  33  Plate  XI V,  Fig.  43.  Plate  XV,  Fig.  45,  Plate  XV,  Fig.  47. 


DEMENTIA  PARALYTICA.  8l 

but  a  miinrte  fraction  of  the  total  number  of  cells  in  the  cortex  at 
this  point  it  will  be  seen  their  presence  makes  but  a  slight  modi- 
fication in  the  general  cortical  arrangement  as  a  whole.  The 
pyramidal  cells  intermediate  in  size  between  the  large  pyramidal 
cells  and  the  Betz  cells  are  of  especial  significance  to  the  writer 
as  perhaps  indicating  that,  with  increased  specialization  of  func- 
tion, carried  on  through  long  periods  of  time,  increased  specializa- 
tion of  the  structure  and  size  of  the  cortical  cells  is  going  on 
hand  in  hand,  and  that  perhaps  the  so-called  Betz  cells,  now 
almost  entirely  limited  to  certain  portions  of  the  central  convolu- 
tions, some  time  in  the  future  may  be  found  in  all  parts  of  the 
cortex.  Their  large  size,  with  resulting  large  amount  of  proto- 
plasm in  the  cell-body  and  large  nucleus,  the  comparatively  enor- 
mous amount  of  'chromatic  substance,  as  possibly  stored  up  food 
products,  all  point  to  great  capacity  for  storing  up  nervous  energy 
to  be  given  out  when  indicated  as  powerful  efferent  impulses,  or, 
on  the  other  hand,  the  capacity  of  receiving  as  equally  powerful 
different  impulses.  Increased  specialization  in  mental  activity 
may  result  in  greater  numbers  of  nerve  cells  being  set  apart  and 
increased  in  size  and  capacity  for  carrying  out  special  functions. 

Paretic  Brain. — Turning  now  to  Brain  B,  the  case  of  demen- 
tia paralytica,  from  which  all  the  succeeding  plates  were  taken,  we 
see  in  Plate  X,  Fig.  29,  a  photograph  of  the  left  hemisphere  of  the 
brain,  natural  size.  The  macroscopic  appearance  at  first  sight 
would  seem  to  indicate  that  there  was  marked  atrophy  and  shrink- 
age in  parts  of  several  convolutions,  especially  the  anterior  central 
and  frontal  convolutions ;  but  a  careful  study  of  the  sections  taken 
from  these  regions  shows  this  not  to  be  altogether  the  case,  or  at 
least  only  to  a  slight  degree.  As  any  one  who  has  studied  brain 
topography  to  any  extent  well  knows,  there  is  much  variation,  not 
only  in  the  shape  and  arrangement  of  any  given  convolution,  but 
also  in  its  size,  so  that  great  care  should  be  observed  in  not  mis- 
taking such  normal  variation  for  atrophy.  A  study  of  the  various 
plates  shown  here  under  a  magnification  of  14  diameters,  con- 
taining' the  entire  cross  section  from  the  several  convolutions  in 
the  brain  and  comparing  them  to  the  preceding  brain  will  make 
this  point  clear.  Here  and  there  a  considerable  quantity  of  the 
cortex  has  been  torn  away  with  the  pia  mater,  whereas  in  many 
places  small  depressions  are  seen  in  which  only  a  very  small  por- 
tion of  the  superficial  layer  of  the  cortex  has  been  torn  away.  The 
convolutions  are  here  well  marked  and  the  sulci  very  deep,  so  that 
there  is  a  large  area  of  cortical  surface.  The  sulci  in  the  middle 
portion  of  the  hemisphere  are  widely  open,  owing  to  the  support 
being  placed  only  in  the  middle  of  the  median  surface  of  the 
hemisphere,  so  that  the  weight  of  the  poles,  anterior  and  posterior, 
caused  these   latter  to  become  depressed,   resulting  in  this  con- 


82 


G.  ALFRED  LAWRENCE. 


spiciions  widening  of  the' central  sulci.  The  posterior  pole  of  the 
brain — the  occipital  lobe — is  practically  normal  macroscopically, 
and  it  will  be  seen  later  also  microscopically,  there  being  none  or 
but  very  slight  pathological  changes  in  the  cortex  in  that  region. 
This  photograph  of  the  brain  was  taken  before  any  blocks  were 
removed,  it  having  been  previously  fixed  in  95  per  cent  alcohol. 
As  each  block  was  removed  the  exact  location  was  noted  and  indi- 
cated in  the  photograph  by  the  letters  of  the  alphabet,  and  the 
place  from  which  the  block  was  taken  enclosed  in  ink  lines. 

Frontal   Conz'ohition. — This   portion   of  the   cortex   is   repre- 
sented bv  the  block  K,  taken  from  the  external  surface  of  the  first 


Plate  X,  Fig.  29. 


frontal  convolution  in  its  middle  third,  the  exact  location  being 
seen  in  Plate  X,  Fig.  29,  K.  The  photomicro2:raph  seen  in  Plate 
X,  Fig.  30,  was  taken  from  a  section  10  microns  in  thickness,  and 
is  magnified  14  diameters.  The  gyrus  here  is  somewhat  narrow, 
and  the  sulci  on  either  side  were  quite  open  and  deep,  and  from 
the  macroscopic  appearance  one  might  at  first  be  inclined  to  think 
that  there  was  some  atrophy  of  the  gyrus ;  but  a  detailed  study 
of  sections  from  this  region  shows  that  this  is  not  the  case. 
Block  K  was  fixed  in  95  per  cent  alcohol ;  this  section  is  i  cm.  in 
length,  .63  cm,  in  width  at  its  widest  part,  and,  as  above  stated, 
10  microns  in  thickness,  being  stained  with  methylene  blue ;  the 


DEMENTIA  PARALYTICA.  83 

other  technique  being  the  same  as  for  all  the  other  plates.  The 
shape  of  the  section  is  somewhat  that  of  a  truncated  pyramid, 
broader  at  the  base  and  narrow  at  the  rounded  vertex.  This  me- 
chanical arrangement  makes  the  cortex  thicker  at  the  vertex  than 
on  the  lateral  aspects.  At  a,  and  enclosed  in  ink  lines,  is  the 
segment  represented  in  Plate  XI,  Fig.  31.  The  first  or  superficial 
layer  is  seen  to  vary  somewhat  in  thickness,  being  thicker  on  the 


Plate  X,  Fig.  30. 


lateral  surface  below  b,  with  another  thickened  portion  below  a, 
a  third  just  to  the  left  of  the  vertex,  and  finally  at  the  lower  part 
of  the  left  lateral  aspect.  The  second  or  pyramidal  cell  layer  does 
not  show  quite  as  distinct  arrangement  of  the  cells  in  a  radial 
direction  as  in  the  corresponding  region  of  the  normal  cortex, 
and  there  is  especially  to  be  noted  the  numerous  portions  of 
minute  capillaries  of  varying  size  and  tortuosity,  singly  or 
branched.  This  second  layer  passes  over  into  the  indistinct  third 
layer,  \^ich  is  lost  below  in  the  pyramidal-shaped  white  medul- 
lary cenier,  which  also  contains  numerous  capillaries.     Plate  XI, 


84  G-  ALFRED  LAWRENCE. 

Fig.  31,  is  a  photomicrograph,  magnified  100  diameters,  of  a 
segment  corresponding  in  position  to  a  of  a  section  adjacent  to 
and  from  the  same  block  as  that  shown  in  Plate  X,  Fig.  30.  The 
section  is  6  2-3  microns  in  thickness,  and  of  the  same  length  and 
breadth  as  that  shown  in  the  preceding  plate.  Decolorization  has 
been  carried  on  to  a  considerable  extent,  about  to  the  same  degree 
as  in  Plate  II,  Fig.  3,  and  thus  causing  the  plate  to  appear  rather 
pale.  Additional  causes  are  the  paucity  of  large  pyramidal  cells 
in  the  second  layer,  and  the  shrunken  condition  of  many  of  the 
cells,  as  well  as  other  pathological  alterations.  The  upper  layer 
averages  .20  mm.  in  thickness,  and  contains  for  the  most  part 
scattered  neuroglia  cells.  The  second  or  pyramidal-cell  layer  is 
1.80  mm.  in  thickness.  Here  is  to  be  found  a  very  similar  ar- 
rangement of  the  cells  to  that  in  the  corresponding  region  of  the 
normal  brain  A.  In  the  upper  portion  are  to  be  seen  the  small 
pyramidal  cells  in  considerable  numbers,  just  below  the  super- 
ficial layer.  Then  they  become  more  scattered,  with  a  tendency 
to  an  arrangement  into  larger  and  smaller  irregular  groups,  the 
cells  becoming  larger  in  the  deeper  portions.  A  little  below  the 
middle  of  this  layer  is  found  a  narrow  strip  at  a,  where  the  small 
pyramids  predominate  almost  to  the  entire  exclusion  of  the  larger 
ones,  which  latter,  however,  are  seen  above  and  below.  Below 
this  again  are  to  be  seen  the  larger  pyramids,  which  finally  give 
way  to  the  irregular  and  spindle  cells  of  the  third  layer.  The 
nerve  cells  themselves  show  various  changes.  Many  of  them 
appear  to  be  atrophied  or  shrunken,  this  process  varying  in  degree 
in  different  cells.  This  in  many  cases  has  resulted  in  the  forma- 
tion of  larger  or  smaller  pericellular  spaces  as  seen  about  many 
of  these  cells,  as  at  P  in  this  plate  and  in  Fig.  P  of  the  text,  for 
instance.  Here  a  large  pericellular  space  completely  surrounds 
the  cell.  The  basal  dendrites  are  represented  by  only  one  small 
shrunken  process  given  off  at  the  left  and  extending  but  a  short 
distance.  The  body  of  the  cell  is  shrunken  and  irregular  in  con- 
tour. A  large  mass  of  yellowish  pigment  is  seen  at  the  base  to  the 
right.  A  small  amount  of  finely  granular  chromophilic  substance 
is  found  about  and  above  the  nucleus.  The  nucleus  itself  is  dis- 
placed downward  into  the  base  of  the  cell-body,  to  the  extreme 
left.  It  is  small,  irregular  in  outline,  and  contains  a  well  defined 
nucleolus  but  no  chromatic  substance.  The  apical  process  is 
shrunken  and  irregular  in  direction,  and  contains  traces  of  chro- 
mophilic substance  in  places.  The  chromatic  substance  in  the 
large  majority  of  these  cells  has  become  diffused  and  decreased  in 
amount  in  variable  degrees,  so  that  a  large  number  of  the  cells 
present  the  appearance  of  chromatolysis  up  to  almost  complete 
disappearance  of  chromatin  in  some  of  them.  These  latter  present 
a  pale,  washed-out  appearance,  as  shown  by  the  cell  marked  Q  in 


DEMENTIA  PARALYTICA.  85 

this  plate  and  seen  enlarged  in  Fig.  Q,  where  only  a  small  amount 
of  chromatin  is  found  in  the  apical  process  and  a  slight  amount 
of  pigment  in  the  lower  part  of  the  base.  Some  cells  show  loss 
of  chromatin  only  about  the  nucleus,  and  are  spoken  of  as  in- 
stances of  central  chromatolysis.  Others  have  a  disappearance  of 
chromatin  at  the  periphery  of  the  cell-body  only,  and  this  condi- 
tion is  known  as  peripheral  chromatolysis.  The  nuclei  of  many 
of  these  cells  are  found  frequently  displaced  to  one  side,  crowded 
into  the  base  of  a  dendritic  process,  near  the  base  of  the  cell-body, 
or  near  the  base,  or  up  into  the  proximal  portion  of  the  apical 
process.  Many  of  these  are  irregular  in  shape  and  diminished  in 
size.  Quite  a  large  pt-oportion  of  the  larger  pyramidal  cells  con- 
tain light  yellowish  pigment  in  variable  quantity  and  usually  at 
the  base  of  the  cell,  often  extending  into  the  base  of  a  dendritic 
process.  The  cell  P,  above  described,  in  addition  to  the  pericellu- 
lar space,  demonstrates  these  last  two  points,  the  nucleus  being 
crowded  into  the  base  of  the  dendritic  process  given  off  on  the 
left  and  a  considerable  deposit  of  pigment  being  found  at  the  base 
and  extending  into  the  right  dendritic  process.  The  cells  contain- 
ing this  pigment  are  marked  with  a  cross,  adjacent  to  them,  in 
this  plate.  It  will  be  seen  that  they  are  to  be  found  mostly  in  the 
middle  and  lower  portion  of  this  layer,  and  also  some  few  scattered 
irregular-shaped  cells  in  the  third  layer.  The  dendritic  processes 
in  many  of  these  cells  end  abruptly  beyond  their  base,  and  in  but 
few  cases  can  they  be  traced  to  any  great  distance  from  the  cell- 
body.  The  apical  process  shares  in  this  general  atrophy,  and 
often  is  curved  and  irregular  in  direction,  instead  of  presenting  a 
regular  straight  course  towards  the  periphery  of  the  cortex.  In 
some  cells  the  nucleus  is  difficult  to  distinguish,  the  limiting  mem- 
brane being  indeterminable  and  the  nucleolus  appearing  to  be  in 
the  midst  and  surrounded  by  only  the  cell-body,  and  usuallv  in  an 
eccentric  position.  Numerous  blood  vessels  are  here  to  be  seen, 
all,  with  thickened  walls  and  pursuing  a  tortuous  course.  Large 
perivascular  spaces  are  also  seen  about  many  of  these  blood  ves- 
sels, as  at  d,  for  instance.  The  third,  or  spindle  or  irregular  cell 
layer  -is  here  .90  mm.  in  thickness,  and  is  made  up  of  irregular 
and  spindle  cells,  some  of  the  former,  as  some  of  the  cells  of 
the  second  layer,  contain  pigmentary  deposits.  Here  also  the 
chromatin  is  found  in  diminished  quantity,  and  various  stages  of 
chromatolysis  are  seen.  The  nucleus  is  diminished  in  size  in 
many  cases  and  does  not  appear  to  be  as  prominent  a  factor  as  in 
the  normal  cells  of  this  region.  The  cells  as  a  whole  appear 
smaller  in  size  and  more  or  less  atrophied,  containing  less  proto- 
plasm in  the  cell-body. as  well  as  a  diminished  amount  of  chro- 
matin. The  blood  vessels  are  here  also  found  to  have  thickened 
walls,  and  are  tortuous  in  direction.     At  e  is  seen  one  of  these 


86  G.  ALFRED  LAWRENCE. 

vessels,  with  thickened  walls  and  surrounded  by  a  large  perivas- 
cular space.  The  entire  thickness  of  the  cortex  at  this  point  is 
found  to  be  2.90  mm. ;  almost  the  same  as  in  the  corresponding 
region  in  Brain  A,  as  seen  in  Plate  11,  Fig.  3.  Counts  were  made 
of  the  nerve  and  neuroglia  cells  in  various  parts  of  this  section  in 
the  same  manner  as  in  the  previous  sections,  and  in  eight  different 
fields  of  36  sq.  mm.  each  of  the  ocular  net-micrometer  from  vari- 
ous portions  of  the  two  lower  layers  for  the  nerve  cell  counts,  and 
in  all  three  layers  for  the  neuroglia  cell  counts.  There  was  found 
to  be  an  average  of  100  nerve  cells  and  56.90  neuroglia  cells  to 
each  square  millimeter  of  surface  of  this  section.  The  small  num- 
ber of  neuroglia  cells  being  due  to  the  methylene  blue  stain  em- 
ployed and  differentiation  carried  on  to  a  considerable  degree  in 
a  section  6  2-3  microns  in  thickness.  In  the  section  shown  in 
Plate  X,  Fig.  30,  10  microns  in  thickness,  and  more  deeply  stained, 
the  number  of  nerve  cells  is  not  quite  so  great,  whereas  the  num- 
ber of  neuroglia  cells  is  almost  six  times  as  great,  although  the 
two  sections  are  quite  near  together  and  from  the  same  block. 
This  is  due  to  the  neuroglia  cells  in  Plate  XI,  Fig.  31,  being  al- 
most completely  decolorized  in  the  greater  differentiation,  where- 
as the  cells,  although  paler,  yet  were  not  decolorized,  and  can  all 
be  made  out.  The  same  method  of  using  the  ocular  net-microm- 
eter was  employed  here  as  in  all  the  other  plates,  and  counts  were 
made  from  eight  different  fields  of  thirty-six  squares  each  from 
different  parts  of  the  second  and  third  layers  of  this  section,  and 
the  average  number  of  nerve  cells  was  found  to  be  82.91  to  the 
square  millimeter  of  surface  of  the  section,  as  compared  to  100 
for  the  same  area  in  Plate  XI,  Fig.  31,  so  that  there  are  on  an 
average  less  nerve  cells  in  this  section,  10  microns  in  thickness, 
than  in  the  section  from  which  Plate  XI,  Fig.  31  was  taken,  which 
was  but  6  2-3  microns  in  thickness,  the  same  stain  being  used  in 
both  cases.  The  nerve  cells,  however,  are  more  deeply  stained  in 
this  latter  section,  and  appear  more  distinct,  and  there  are  also 
more  large  cells.  The  neuroglia  cells  in  eight  different  fields  of 
thirty-six  squares  each  from  various  parts  of  the  three  cortical 
layers  average  303  to  the  square  millimeter  of  surface  of  the  sec- 
tion, as  contrasted  to  56.90  to  the  square  millimeter  in  Plate  XI, 
Fig.  31.  Here  increased  thickness  makes  a  difference  in  favor 
of  this  plate,  and  in  addition  to  that  the  deeper  stain  with  less 
decolorization  cause  all  the  neuroglia  cells  to  appear  more  promi- 
nent. As  stated  before  it  was  found  that  sections  from  6  2-3  to 
10  microns  in  thickness  contain  all  the  nerve  cells  to  be  seen  in  one 
plane.  As  the  neuroglia  cells  are  much  smaller  in  diameter  and 
often  arranged  in  dense  clusters,  there  may  be  a  greater  number 
in  a  section  10  microns  in  thickness  than  in  one  6  2-3  microns  in 
thickness.     (See  Table  II.) 


DEMENTIA  PARALYTICA. 


87 


Central  Region. — Turning'  to  the  region  posterior  to  the  one 
just  discussed,  we  come  to  the  central  re2,'ion,  or  motor  area,  made 
up  of  the  anterior  and  posterior  central  convolutions.  Typical  of 
the  anterior  central  convolution  in  its  upper  portion  is  the  section 
rep'"esc  nted  in  Plate  XI.  Fi^".  32,  under  a  magnification  of  14 
diameters.  The  exact  location  of  the  block  from  which  this  sec- 
tion was  taken  is  indicated  by  the  ktter  D  in  Plate  X,  Fig.  29. 
The  wide  separation  of  the  convolutions  f^om  one  another,  with 
resulting  gaping  sulci,   is  especially  marked  in  this  region.     As 


Plate  XI,  Fig.  22- 


previously  mentioned,  this  is  largely  due  to  mechanical  agencies, 
a  central  support  permitting  the  opposite  poles,  owing  to  their 
weight,  to  become  depressed  and  force  open  the  sulci  in  this 
region  during  the  process  of  hardening  or  fixation.  In  the  re- 
moval of  the  pia  mater,  small  portions  of  the  adhering  cortex  have 
been  removed  in  places.  This  is  seen  just  below  the  letter  O,  and 
in  many  places  in  the  convolutions  both  anterior  and  posterior  to 
this.     By  referring  back  to  Plate  TIT,  Fig.  7  of  the  normal  brain 


88  G.  ALFRED  LAWRENCE. 

it  will  be  seen  that  this  section  was  taken  from  approximately  the 
same  relative  position  of  the  convolution  as  that  seen  in  Plate  III, 
Fig.  7,  and,  furthermore,  the  two  convolutions  are  quite  similar 
in  shape ;  this  convolution  being  somewhat  broader  and  less 
rounded  at  the  vertex  than  that  of  the  normal  brain,  however. 
The  outer  cortical  layer  is  here  more  irregular  and  torn  than  in 
Plate  III,  Fig.  7,  and  at  the  vertex  of  the  convolution  at  b  the 
outer  part  of  the  first  layer  is  seen  stripped  off  for  some  distance. 
This,  of  course,  is  an  artefact,  the  detached  part  being  more 
adherent  to  the  stripped  off  pia  than  to  the  cortex  below.  This 
outer  layer  furthermore  presents  a  somewhat  irregular  contour, 
being  broken  in  places  as  at  c  and  d.  The  layer  is  thicker  oppo- 
site a,  and  on  the  left  lateral  aspect,  than  elsewhere.  The  second 
or  pyramidal  cell  layer  shows  the  general  radial  direction  of  the 
cells,  but  not  so  well  marked  as  in  Plate  III,  Fig.  7.  The  chief 
point  of  interest,  however,  is  almost  complete  disappearance  of 
the  Betz  cells,  which  are  seen  so  prominently  in  this  region  in  the 
normal  brain  in  plates  of  this  magnification  (14  diameters).  In 
photomicrographs  of  100  diameters  we  will  find  this  disappear- 
ance is  not  complete,  and  that  the  cells,  although  much  atrophied 
and. pale,  so  as  to  scarcely  appear  under  the  lower  power,  are 
much  more  apparent  here,  and  are  seen  in  all  stages  of  dissolution. 
In  this  plate  only  scattered  Betz  cells  are  seen  singly  or  in  small 
groups  at  wide  intervals,  and  these  few  are  small,  shrunken  and, 
for  the  most  part,  pale.  Fig.  R  is  a  drawing  of  the  large  Betz 
cell  marked  R  in  this  plate.  The  nucleus  is  quite  centrally  situ- 
ated, with  a  large  distinct  nucleolus  and  some  faint  chromatic 
substance.  Some  few  chromophilic  bodies  are  seen  interspersed 
among  the  finely  granular  chromatic  substance.  The  cell  pro- 
cesses are  pale,  irregular,  and  soon  terminate  at  a  short  distance 
from  the  cell-body.  No  pigment  is  found  in  this  cell.  Figs.  S 
and  T  show  two  other  near-by  cells,  the  former  containing  an 
eccentric  nucleus,  irregular,  shrunken  cell-body,  with  some  pig- 
ment at  the  left  of  the  nucleus.  The  processes  being  irregular  and 
short.  The  cell  in  Fig.  T  is  much  shrunken  and  distorted,  the 
nucleus  irregular,  a  small  nucleolus,  and  but  little  diffuse  chro- 
matic substance.  There  are  no  basal  processes,  and  the  apical 
process  is  narrow  and  irregular  in  direction.  Numerous  capil- 
laries are  seen  with  thickened  walls,  and  some  with  perivascular 
spaces.  The  third  layer  is  indistinct,  and  fades  into  the  white 
medullary  substance,  where  many  large  capillaries  with  thickened 
walls,  tortuous  course  and  perivascular  spaces  are  found.  At  a, 
and  enclosed  in  ink  lines,  is  the  segment  of  this  section,  corre- 
sponding in  position  to  that  seen  in  Plate  XI,  Fig.  33.  This  sec- 
tion is  8  mm.  wide,  6.5  mm.  long,  and  10  microns  in  thickness, 
fixed  in  95  per  cent  alcohol,  stained  with  methylene  violet,  and 


DEMENTIA  PARALYTICA.  89 

other  technique  similar  to  all  the  other  sections.  Plate  XI,  F*^. 
33,  is  the  photomicrograph  magnified  100  diameters  of  a  segment 
corresponding  to  a  of  Plate  XI,  Fig.  32,  and  from  a  section  taken 
from  the  same  block,  and  but  a  short  distance  from  the  above. 
At  this  point  the  first  or  outer  layer  measures  .25  mm.  in  thick- 
ness, whereas  in  Plate  XI,  Fig.  32,  it  would  measure  at  least  .40 
mm.  in  thickness.  It  contains  numerous  neuroglia  cells,  with  here 
and  there  a  small  pale  nerve  cell  in  which  is  situated  a  small 
nucleus  surrounded  by  a  mere  trace  pf  chromatic  substance.  Be- 
low this  is  the  second  or  pyramidal  cell  layer,  measuring  1.30  mm. 
in  thickness.  In  the  upper  parts  the  pyramids  are  seen  to  be  small 
and  quite  closely  packed  together.  About  the  middle  of  the  layer 
they  are  seen  to  be  much  larger  and  more  scattered.  Below  this 
again,  at  a,  is  seen  a  region  containing  for  the  most  part  only 
small  pyramids,  and  this  finally  merges  into  the  lower  portion  of 
this  layer,  where  are  seen  the  large  and  giant  pyramidal  cells. 
These  latter,  or  Betz  cells,  are  seen  in  irregular  groups  or  "nests," 
consisting  of  from  one  to  several  (six  or  more)  cells.  All  of  these 
cells  show  a  diminished  amount  of  chromophilic  substance  and 
no  distinct  granules.  Various  stages  of  advanced  chromatolysis 
are  seen,  from  a  general  diffusion  of  the  chromatic  substance  to 
almost  complete  absence  of  the  same.  The  cells  are  for  the  most 
part  shrunken,  the  nuclei  small  and  indistinct,  displaced  in  many 
cases,  and  the  cell  processes  atrophied  and  tortuous.  Many  of 
these  larger  cells  contain  a  varying  amount  of  yellowish  pigment. 
Fig.  U  shows  the  cell  marked  U  in  the  plate.  No  processes  are 
seen,  the  cell-body  is  shrunken  and  contains  but  a  small  amount 
of  diffused  chromatin,  showing  no  structure  and  pale  in  color. 
The  nucleus  is  small,  shrunken  and  indistinct,  with  a  pale  nucleo- 
lus. No  pigment  is  to  be  seen  in  the  cell.  To  the  left  of  the  cell- 
body  is  a  small  pericellular  space.  Several  neuroglia  cells  are 
seen  in  apparent  direct  contact  with  the  cell-body  and  others  in  the 
pericellular  space  and  the  wall  of  the  latter.  The  cell  just  below 
and  to  the  left  of  this  in  the  plate  is  similar  in  regard  to  the 
amount  of  chromatin,  is  pale,  and  the  nucleus  and  nucleolus  are 
not  visible.  Three  processes  are  seen  given  off  at  the  base,  but 
atrophied  and  extending  for  only  a  short  distance.  A  small  peri- 
cellular space  is  seen  about  this  cell  also.  The  cell  just  below 
and,  to  the  right  of  this,  and  marked  V  in  the  plate  and  seen  in 
Fig.  V,  shows  the  same  grade  of  chromatolysis.  The  remnant  of 
a  shrunken  and  atrophied  process  is  seen  at  the  base  on  the  right. 
The  shrunken  nucleus,  with  pale  nucleolus,  is  centrally  situated, 
and  below  this  are  found  diffused  pigmentary  deposits.  Through- 
out the  cell-body,  less  in  the  upper  than  in  the  lower  part,  is 
scattered  pale  diffuse  chromatic  substance,  and  without  any 
definite  arrangement.     A  narrow  pericellular  space  is  seen  along 


90 


G.  ALFRED  LAWRENCE. 


the  right  side  of  this  cell.  The  general  contour  and  lack  of  struc- 
ture are  seen  in  Fig.  V.  Here,  too,  neuroglia  cells  are  seen  lying 
upon  and  in  close  juxtaposition  to  the  cell-body.  Numerous  blood 
vessels  with  thickened  and  tortuous  walls  and  perivascular  spaces 
are  seen  throughout  this  layer.  The  third  or  spindle  or  irregular 
cell  layer  here  measures  .90  mm.  in  thickness,  and  is  made  up  of 
shrunken  spindle  and  irregular  cells,  pale,  and  containing  but  a 
small  amount  of  diffuse  chromophilic  substance.  Many  of  them 
are  surrounded  by  pericellular  spaces  of  varying  size.     The  letter 


Plate  XI,  Fig.  34. 


W  indicates  one  of  these  spindle  cells  seen  in  the  drawing,  Fig.  W. 
The  polar  processes  are  here  filamentous,  and  distorted  in  direc- 
tion, the  cell-body  shrunken  and  containing  but  a  small  amount 
of  diffuse  chromatic  substance,  so  that  it  is  pale  in  color,  the 
nucleus  is  small  and  indistinct,  and  contains  a  small  nucleolus. 
The  cell-body  is  partially  surrounded  by  a  distinct  pericellular 
space,  with  a  neuroglia  cell  upon  the  edge  at  one  point.  Numer- 
ous blood  vessels  with  thickened  walls  and  perivascular  spaces  are 
also  seen  in  this  layer.  The  entire  depth  of  the  cortex  here  is 
3.05  mm.,  all  three  layers  being  slightly  thicker  than  in  Plate  III, 
Fig.  8,  of  Brain  A,  the  first  layer  being  .05  mm.,  the  second  .15 


DEMENTIA  PARALYTICA. 


91 


mm.,  and  the  third  .20  mm.,  thicker  than  in  the  latter.  As  varia- 
tions of  this  extent  are  found  in  sections  of  convolutions  in  close 
proximity,  and  even  in  different  parts  of  the  same  section  in  any 
brain,  it  seems  doubtful  to  the  writer  whether  we  can  attach  any 
special  significance  to  such  a  slight  variation,  due  possibly  to  me- 
chanical causes,  acting  in  embryonic  or  even  post  embryonic  life. 
Counts  of  the  nerve  and  neuros:lia  cells  here  show  a  decided  fall- 


Plate  XII,  Fig.  35. 


ing  off  in  number  of  the  former.  This  section  is  6  2-3  microns  in 
thickness  and  stained  with  methylene  violet.  The  same  method 
with  the  ocular  net-micrometer  was  used,  counting  the  nerve  cells 
in  eight  different  fields  of  thirty-six  square  millimeters,  each  in 
various  parts  of  the  second  and  third  cortical  layers,  and  the 
neuroglia  cells  in  the  same  number  of  different  fields  in  all  these 
cortical  layers.  The  average  number  of  nerve  cells  to  each  square 
millimeter  of  surface  of  the  section  was  found  to  be  but  39.60, 
whereas  the  average  number  of  neuroglia  cells  to  the  same  area 
was  found  to  be  204.  The  number  of  nerve  cells  is  thus  seen  to 
be  much  diminished  as  compared  to  Plate  III,  Fig.  8,  the  corre- 
sponding region  of  the  normal  brain  A,  where  there  are  an  aver- 


92 


G.  ALFRED  LAWRENCE. 


age  of  95  nerve  cells  to  the  square  millimeter  of  surface  of  the 
section.  The  number  of  neuroglia  cells  is  also  less  here,  being 
204  in  this  plate  in  comparison  to  293  in  Plate  III,  Fig.  8.  The 
latter  section  is.  however,  10  microns  in  thickness,  as  compared  to 
6  2-3  microns  for  this  plate,  and  as  previously  noted,  owing  to  the 
small  size  and  close  aggregation  of  the  neuroglia  cells,  more 
would   be  normally   found   in  the  thicker  section,  although   this 


Plate  XII,  Fig.  36. 


hardl}-  accounts  for  the  great  difference,  as  both  were  stained  in 
the  san.e  manner  with  methylene  violet.  Plate  XI,  Fig.  34,  is  a 
photomicrojraph,  magnified  14  diameters,  from  a  section  taken 
from  the  point  L  of  the  upper  portion  of  the  anterior  central  con- 
vokition  of  Brain  P>  (see  Plate  X,  Fig.  29),  and  as  seen  by  refer- 
ring to  this  latter,  is  from  a  more  inferior  portion  of  this  gyrus 


DEMENTIA  PARALYTICA.  93 

than  the  section  represented  in  Plate  XI,  Fig.  32.     This  section 
was  fixed  in  95  per  cent  alcohol,  is  6  2-3  microns  in  thickness,  and 
stained  with  methylene  violet.     The  first  la3'er  is  seen  to  be  fairly 
uniform  in  thickness  at  the  lower  two-thirds,  as  seen  at  c.    Above, 
and  at  the  vertex,  and  also  along  the  anterior  aspect  of  the  con- 
volution, as  at  d,  the  surface  is  more  or  less  torn  and  irregular, 
due  to  carrying  away  of  small  fragments  with  the  adherent  pia. 
By  referring  to  Plates  XI,  Fig.  32,  and  XIII,  Fig.  39,  the  varia- 
tions in  shape  and  mechanical  arrangement  of  the  convolution  in 
adjacent  portions  will  be  noted.    In  Plate  XI,  Fig.  32,  the  vertex 
is   broadly    rounded   and    somewhat    flattened.      In    Plate    XIII, 
Fig.  39,  the  vertex  is  more  narrow  and  pointed,  while  in  this  plate, 
intermediate  in  position  between  the  above  two  plates  the  vertex 
is  less  pointed.     Large  perivascular   spaces   are   noted   in  many 
places  throughout  this   section,   especially  marked   in   the   upper 
portion  to  the  left  of  the  vertex,  where  but  a  fragment  of  the 
blood  vessel  is  to  be  seen  only  at  the  lowest  point  of  an  enormous 
perivascular  space.     The  radial  arrangement  of  the  cells  is  but 
poorly  shown,  the  Betz  cells  seem  to  have  disappeared  almost  en- 
tirely in  the  second  layer,  in  marked  contrast  to  the  plates  of  the 
same  magnification  of  Brain  A.     (Plates  III.  Fig.  7;  I\',  Fig.  9, 
and  lY,  Fig.  11.)     Under  a  high  magnification,  however,  the  rem- 
nants of  many  of  these  Betz  cells  can  be  made  out,  showing  vari- 
ous pathological  changes.     The  other  nerve  cells  also  show  a 
wealth   of  pathological   change  of  varying   degree  and   kind   to 
which  the  nerve  cell  is  subjected — all  grades  of  chromatolysis, 
pigmentation,  atrophy,  and  shrinkage  of  the  nerve  cells  and  pro- 
cesses,  with   larger   or    smaller   pericellular    spaces.      Numerous 
capillaries,  with  thickened  walls  and  perivascular  spaces,  are  seen 
scattered  throughout  the  various  parts  of  the  section.     The  actual 
size  of  this  section  is  8  mm.  wide  at  the  point  opposite  d.  8.5  mm. 
long,  and  6  2-3  microns  in  thickness.     At  the  points  a  and  h  are 
seen  the  Betz  cells,  shown  under  a  magnification  of  1,400  diame- 
ters in  Plates  XII,  Fig.  35,  and  XII,  Fig.  36.     The   former  of 
these  is  a  photomicrograph  as  stated,  under  a  magnification  of 
1,400  diameters  of  the  nerve  cell,    indicated  by  the   letter  a  in 
Plate  XI,  Fig.  34.     By  referring  to  this  latter  plate,  and  then  to 
Plate  X,  Fig.  29,  we  can  locate  almost  the  exact  position  of  this 
cell  in  the  cortex  of  Brain  B.    The  cell-body  is  seen  shrunken  and 
deformed,  lying  in  a  pericellular  space  partially  surrounding  it. 
The  nucleus  is  eccentric,  being  crowded  over  to  the  extreme  edge 
of  the  cell-body  on  the  right  side.     It  is  also  shrunken  and  indis- 
tinct, but  contains  a  well-marked  and  prominent  nucleolus.     The 
apical  process  above  and  to  the  right  appears  quite  sharply  de- 
flected at  a  point  but  a  short  distance  from  the  base,  but  this  is 
not  really  the  case,  as  the  portion  from  a  to  the  edge  of  the  plate 


94  G.  ALFRED  LAWRENCE. 

is  one  of  the  walls  of  a  blood  vessel,  the  opposite  wall  not  being 
seen  in  this  plate  at  all.  At  the  point  a,  this  apical  dendritic 
process  appears  to  come  in  direct  contact  with  this  portion  of  the 
wall  of  the  blood  vessel,  and  is  there  lost  to  view.  The  other 
dendritic  processes— seven  in  all — are  shrunken,  and  contain  a 
small  amount  of  diffuse  chromatin.  Within  the  cell-body  the 
chromatin  is  considerable  in  amount,  and  quite  generally  diffused 
in  fine  granules  throughout  the  cell-body,  lacking  any  definite 
structural  arrangement.  There  is  a  somewhat  greater  amount 
at  the  base  to  the  left  and  below  the  nucleus,  and  also  at  the  upper 
part  of  the  cell-body.  Above  and  to  the  left  of  the  nucleus,  where 
the  cell-body  appears  most  pale,  and  extending  into  the  base  of  the 
dendritic  processes  here,  is  a  considerable  mass  of  yellowish  pig- 
ment. Numerous  neuroglia  cells  are  seen  in  the  vicinity  of  this 
Betz  cell.  Plate  XII,  Fig.  36,  is  also  a  photomicrograph,  magni- 
fied 1.400  diameters,  of  another  of  these  Betz  cells  trom  the  point 
h  of  Plate  XI,  Fig.  34.  Here  there  is  but  Httle  diffuse  chromatin, 
confined  principally  to  the  base  of  the  dendritic  process  given  off 
on  the  right.  All  the  lower  part  of  the  cell-body,  excepting  this 
portion,  contains  palely  yellow  pigment.  The  nucleus  is  displaced 
almost  to  the  extreme  edge  of  -the  cell-body,  and  lies  just  below 
the  two  neuroglia  cells  seen  at  a.  The  nucleolus,  on  this  account, 
can  not  be  determined  at  this  plane.  On  microscopic  examination 
the  nucleus  is  found  to  be  shrunken  and  indistinct.  Numerous 
neuroglia  cells  are  seen  upon  and  in  the  immediate  vicinity  of  this 
cell.  The  basal  dendritic  process  b,  which  is  but  faintly  seen  here, 
owing  to  its  lying  in  a  somewhat  lower  plane,  has  eight  neuroglia 
cells  in  close  apposition  to  it.  The  dendritic  process  on  the  right 
can  be  traced  for  some  distance,  is  somewhat  shrunken,  and  con- 
tains no  chromatic  substance.  Another  small  dendritic  process  is 
given  off  from  the  base  opposite  the  point  c,  and  being  in  a  lower 
plane,  only  its  base  is  seen  here.  It  is  colorless,  and  extends  but 
a  short  distance  from  the  cell-body.  The  apical  dendritic  process 
contains  no  chromatin,  and.  as  seen,  has  several  neuroglia  cells 
surrounding  it  a  short  distance  from  its  base.  A  large  pericellu- 
lar space  almost  entirely  surrounds  the  cell,  excepting  at  the  base 
to  the  left.  Plates  XII,  Fig.  37,  and  XII,  Fig.  38,  are  photomi- 
crographs of  the  same  magnification  (1,400  diameters),  taken 
from  an  adjacent  section  of  the  same  block  as  the  two  preceding 
plates,  and  are  also  6  2-3  microns  in  thickness.  This  section  was 
prepared  in  exactly  the  same  way,  with  the  exception  that 
methylene  blue  was  used  as  the  stain  instead  of  methylene  violet. 
This  will  be  at  once  apparent  upon  noticing  the  neuroglia  cells, 
which  are  here  pale  and  washed  out,  many  to  the  point  of  com- 
plete decolorization,  so  as  not  to  be  seen  at  all.  The  Betz  cell  in 
the  center  of  Plate  XII,  Fig.  37,  is  seen  surrounded  by  a  large 


DEMENTIA  PARALYTICA. 


95 


pericellular  space.  All  the  processes,  four  in  number,  including 
the  apical  dendritic  process,  are  pale,  and  terminate  but  a  short 
distance  from  the  cell-body.  The  nucleus  is  eccentrically  situated 
near  the  wall  at  the  left,  is  small,  and  contains  a  large  nucleolus, 
but  no  nuclear  network.  Within  the  cell-body  finely  granular 
chromatic  substance  is  found  at  the  base  below  and  to  the  right  of 


Plate  XII,  Fig.  Z7- 

the  nucleus.  There  is  no  pigment  present.  This  cell  presents  an 
advanced  stage  of  partial  chromatolysis.  Above  and  to  the  right 
is  an  almost  indeterminable  mass,  which,  under  the  1-12  inch  oil- 
immersion  objective,  appears  to  be  the  remnant  of  a  capillary, 
surrounded  by  a  large  perivascular  space.  Other  cells  are  seen 
here  in  various  stages  of  disintegration,  surrounded  by  large  peri- 
cellular spaces,  some  containing  none  or  onlv  the  remnants  of  den- 


96 


G.  ALFRED  LAWRENCE 


dritic  processes,  indistinct  and  shrunken  nuclei,  some  distinct  nu- 
cleoli and  others  none  at  all,  and  all  in  a  more  or  less  advanced 
state  of  chromatolysis,  with  but  little  of  the  diffused  stained  chro- 
matic substance  present.  The  neuroglia  cells  that  are  visible  at 
all  are  pale  and  poorly  stained,  while  many  are  almost  or  corn- 


Plate  XII,  Fig.  38. 


pletely  decolorized.  Plate  XII,  Fig.  38,  is  a  photomicrograph  of 
a  Betz  cell  on  the  same  section  and  but  a  short  distance  from  the 
cells  of  the  preceding  plate,  and  under  the  same  magnification 
(1,400  diameters).  Here  there  is  almost  complete  chromatolysis, 
there  being  but  little  finely  granular,  diffuse  chromatic  substance 
scattered  in  the  cell-body,  slightly  more  at  the  base  than  above 
the  nucleus.     The  latter  is  small,  rounded,  centrally  situated,  and 


DEMENTIA  PARA  LYTIC  A. 


97 


contains  a  large,  rounded,  distinct  nucleolus.  -  The  three  basal  pro- 
cesses are  narrow,  pale,  and  terminate  at  no  great  distance  from 
the  cell-body.  The  apical  process  is  pale  and  slender,  extending 
for  some  little  distance  before  coming"  to  an  end.  Part  of  a  pale, 
atrophied  cell  is  seen  to  the  right  of  the  same.  The  ghosts  of 
several  neuroglia  cells  may  be  seen  here,  but  most  of  them  are 
completely  decolorized. 

Plate  XIII,  Fig.  39,  as  will  be  seen  by  referring  to  Plate  X, 
Fig.  29,  is  from  the  lower  portion  of  the  upper  third  of  the  an- 
terior central  convolution,  from  the  point  marked  O,  and  is  magni- 
fied 14  diameters.    This  section,  as  already  mentioned,  is  found  to 


Plate  XIII,  Fig.  40. 


vary  somewhat  in  shape  from  that  of  the  preceding  sections 
shown  in  Plate  XI,  Fig.  32,  and  Plate  XI,  Fig.  34,  being  narrower 
and  more  pointed  at  the  vertex.  From  the  strip  marked  a,  and 
enclosed  in  ink.  the  structure  and  arrangement  of  the  nerve  cells 
were  carefully  studied,  and  both  nerve  and  neuroglia  cell  counts 
made  and  will  be  referred  to  again  later.  The  irregularity  and 
difference  in  thickness  of  the  first  layer  in  different  parts  is  to  be 
noted,  being  especially  thick  at  h,  where  it  almost  presents  the 
appearance  of  an  artefact,  but  under  a  high  power  no  derange- 
ment of  the  structure  can  be  made  out.     At  a  the  laver  is  seen  to 


98  G.  ALFRED  LAWRENCE. 

be  very  thin,  owing  to  some  of  the  surface  of  the  cortex  having 
remained  adherent  to  and  been  stripped  off  with  the  thickened 
pia  mater.  Large  perivascular  spaces  are  to  be  especially  noticed 
in  the  subcortical  portion  of  the  section.  Here  is  to  be  noted  the 
almost  entire  absence  of  the  Betz  or  giant  pyramidal  cells  in  the 
ixjwer  part  of  the  second  layer,  although  some  large  pyramidal 
cells  are  to  be  found,  they  are  not,  however,  so  large  -nor  are  they 
arranged  in  such  distinct  groups  as  in  the  region  higher  up.  Un- 
der higher  magnification  the  remnants  of  some  of  these  Betz  cells 
are  seen  in  various  stages  of  necrosis  and  disintegration.  The 
cortex  lacks  the  distinct  striated  appearance  seen  in  the  sections 
of  the  normal  cortex.  This  layer  passes  indistinctly  into  the  third 
or  spindle  cell  layer,  which  in  turn  is  lost  in  the  white  medullary 
substance  below.  Numerous  capillaries  are  seen,  many  with 
thickened  walls  and  perivascular  spaces  throughout  the  section. 
This  section  was  fixed  in  95  per  cent  alcohol,  sectioned  10  microns 
in  thickness,  stained  with  methylene  violet,  with  other  technique 
similar  to  that  of  all  the  previous  sections.  The  actual  size  of  the 
section  is  9  mm.  at  its  greatest  width  and  13  microns  in  length. 
The  strip  a  varies  from  that  of  Plate  XI,  Fig.  33,  only  in  the 
number  and  arrangement  of  the  cells  in  the  second  layer.  At  this 
point  the  three  layers  are  respectively  .20  mm.,  2.00  mm.,  and  .90 
mm.  in  thickness.  The  first  layer  contains  some  few  scattered 
irregular  nerve  cells  and  numerous  neuroglia  cells.  The  second 
layer  contains  small  pyramidal  cells  above,  increasing  in  size  until 
a  little  above  the  middle  of  the  layer  is  a  strip  some  .30  mm.  in 
width,  in  which  are  to  be  seen  large  pyramidal  cells  arranged 
singly  or  in  irregular  groups.  Some  of  these  cells  almost  ap- 
proach the  giant  pyramidal  cells  in  size.  Many  of  them  show  but 
a  slight  shrinkage  and  contain  an  almost  normal  amount  of  chro- 
matic substance.  The  chromophilic  bodies,  however,  are  not  as 
numerous  or  as  large  as  in  the  normal  brain.  Other  cells  show  a 
complete  absence  of  chromophilic  bodies,  but  contain  the  chro- 
matic substance  diffused  throughout  the  cell  in  minute  particles. 
Still  others  are  pale,  and  contain  but  little  chromatic  substance. 
The  nuclei  are  larger,  less  eccentric,  and  there  is  a  less  degree  of 
atrophy  of  the  cell-body  and  processes.  Below  this  is  a  region  of 
small  pyramidal  cells  with  only  a  few  scattered  larger  pyramidal 
cells  merging  into  the  lower  part  of  the  layer,  where  large  pyrami- 
dal cells  are  again  seen  scattered  irregularly  among  the  smaller 
cells.  These  large  pyramidal  cells  are  somewhat  smaller  than  the 
giant  pyramidal  or  Betz  cells  seen  in  the  upper  part  of  this  con- 
volution. These  cells  show  more  advanced  pathological  changes, 
in  some  cases  marked  atrophy  and  shrinkage  with  large  pericellu- 
lar spaces,  atrophy  of  the  dendritic  processes,  eccentricity  and 
shrinkage  of  the  nucleus,  pigmentary  deposits,  complete  absence 


DEMENTIA  PARALYTICA. 


99 


of  or  but  a  small  amount  of  diffuse  chromatic  substance.  The 
third  layer  presents  the  same  general  appearance  as  in  the  pre- 
ceding plate  (XI,  Fig.  33),  with  many  cells  much  shrunken  and 
atrophied  and  little  or  no  chromatic  substance  within  the  same, 
and  surrounded  by  pericellular  spaces  of  varying  size.  Numer- 
ous large  and  small  capillaries  are  seen  scattered  throughout  this 


Plate  XIII,  Fig.  39. 


section,  with  thickened  walls  and  surrounded  by  larger  or  smaller 
perivascular  spaces.  The  entire  depth  of  the  cortex  here  is  3.10 
mm.,  the  second  layer  being  slightly  thicker  than  in  Plate  XI, 
Fig.  33.  The  nerve  cells  were  found  to  average  but  36.50  to  the 
square  millimeter  of  surface  of  the  section  here ;  less  than  in  any 
of  the  other  plates,  whereas  the  neuroglia  cells  average  289  to  the 
square  millimeter  of  surface  of  the  section,  almost  as  great  a  num- 


iOO  G.  ALFRED  LAWRENCE. 

ber  as  in  the  previous  sections  of  the  same  thickness,  ten  microns, 
and  stained  with  methylene  violet.  The  most  conspicuous  differ- 
ence between  this  and  Plate  XI.  Fig.  33,  higher  up  in  the  convolu- 
tion, is  the  arrangement  of  the  large  pyramidal  cells,  the  absence  of 
the  typical  Betz  cells,  and  on  the  whole  less  advanced  pathological 
changes.  Plate  XIII,  Fig.  40,  is  a  photomicrograph  magnified 
fourteen  diameters  of  a  section  from  the  block  B  of  Plate  X,  Fig. 
29,  and  is  thus  seen  to  be  situated  a  little  above  the  middle  of  the 
posterior  central  convolution.  This  section  is  6  2-3  microns  in 
thickness,  8  mm.  in  length,  and  9  mm.  in  width  at  the  widest  point, 
was  fixed  in  95%  alcohol,  stained  with  methylene  blue,  and  other 
technique  similar  to  that  of  all  previously  described  sections.  This 
section  at  the  vertex,  especially  to  the  left,  shows  the  striated  ap- 
pearance of  cell  arrangement  very  well,  but  upon  the  anterior  and 
posterior  aspects  of  the  gyrus  it  is  but  indistinctly  shown.  The 
first  layer  is  fairly  uniform  in  thickness  with  broken  spaces  here 
and  there,  especially  about  the  entrance  of  capillaries.  This  layer  is 
somewhat  thicker  in  certain  places  than  in  others.  At  a,  for  in- 
stance, it  is  thicker  than  at  the  vertex.  This  section  has  a  broad, 
flattened  vertex  with  considerable  cortical  area  on  both  the  anterior 
and  posterior  surfaces.  The  cortex  opposite  the  angles  c  and  b  is 
somewhat  thicker  than  elsewhere.  This  mechanical  arrangement 
admits  of  a  large,  broad  mass  of  fibres  from  various  parts  of  this 
and  the  adjacent  regions  of  the  brain,  leaving  from  and  entering 
into  relations  with  the  cells  of  this  portion  of  the  cortex.  The 
section  is  broken  (an  artefact)  at  the  left  and  numerous  capillaries 
are  found  scattered  throughout  all  the  cortical  layers  and  also  the 
white  medullary  center.  The  segment  represented  in  Plate  XIII, 
Fig.  41,  was  taken  from  a  point  corresponding  to  a,  but  from  an 
adjacent  section  of  the  same  block,  and  is  magnified  100  diameters. 
It  is  from  relatively  the  same  position  as  the  segment  shown  in 
Plate  VII,  Fig.  19,  the  strip  a  of  Plate  VI,  Fig.  18,  of  the  normal 
brain,  but,  as  will  be  seen  by  referring  to  the  latter,  the  shapes  of 
the  two  sections  are  quite  different.  The  distribution  and  arrange- 
ment of  the  cells  in  this  plate  is  somewhat  different  from  that  in 
Plate  VII,  Fig.  19,  also.  In  this  latter,  as  already  described,  some 
large  pyramidal  cells  are  irregularly  distributed  in  parts  of  the 
upper  half  of  the  second  layer,  followed  by  a  narrow  region  made 
up  almost  exclusively  of  small  pyramidal  cells  to  be  followed  by 
larger  pyramidal  cells  in  the  lower  portion  of  this  layer.  In  this 
plate,  however,  there  are  but  few  of  the  larger  pyramidal  cells  in 
the  upper  portion  of  the  second  layer,  there  being  practically  only 
small  pyramidal  cells  in  this  upper  portion  with  the  larger  pyra- 
mids mostly  in  the  lower  portion  of  this  second  layer.  The  cell 
seen  in  the  lower  part  near  the  center  (a,  Plate  XIII,  Fig.  41), 
approaches  in  size  to  the  Betz  cell  type.     The  first  or  superficial 


DEMENTIA  PARALYTICA.  lOI 

layer  here  contains  nothing  but  capillaries  and  neuroglia  cells  and 
is  .25  mm.  in  thickness.  The  second  or  pyramidal  cell  layer  is 
1.40  mm.  in  thickness  and  shows  not  only  numerous  capillaries 
with  irregular  and  thickened  walls,  but  also  the  cells  in  variom 
pathological  conditions.  Chromatolysis  is  complete  in  many  of 
these  cells  as  in  the  large  pyramidal  cell  marked  a  for  instance, 
where  only  traces  of  minute  finely  powdered  chromatin  can  be  seen 
in  some  parts  of  the  cell-body.  Here  also  the  nucleus  is  indistinct, 
with  a  well  marked  nucleolus,  and  the  basal  processes  are  much 
atrophied,  terminating  but  a  short  distance  from  the  cell-body.  A 
small  pericellular  space  is  seen  at  the  base  of  this  cell-body.  Many 
cells  show  eccentricity  of  the  cell  nucleus,  shrinkage  of  the  cell- 
body,  various  grades  of  chromatolysis,  pigmentation,  atrophy,  and 
distortion  of  the  dendritic  processes  and  are  surrounded  by  peri- 
cellular spaces.  The  capillaries  are  numerous,  have  thickened 
and  irregular  walls,  and  are  surrounded  by  perivascular  spaces  of 
varying  "size  and' extent.  Numerous  neuroglia  cells  are  also  inter- 
spersed about  the  cells  and  capillaries  in  this  layer.  The  third  or 
ipindle  cell  layer  is  only  partially  seen  in  this  plate,  and  is  about 
.90  mm.  in  thickness  (only  upper  portion  shown  in  Plate  XIII, 
Fig.  41),  and  is  similar  to  that  in  preceding  plates  of  the  motor 
region,  and  contains  for  the  most  part  shrunken  and  irregular 
spindle  and  polygonal  shaped  cells,  with  numerous  neuroglia  cells 
and  capillaries  interspersed  among  them.  Most  of  these  cells 
show  the  various  pathological  processes  mentioned  above  for  the 
pyramidal  cells.  The  cortex  here  thus  measures  2.55  mm.  in 
thickness,  almost  the  same  as  for  the  two  upper  layers  in  Plate 
VII,  Fig.  19,  but  here  the  third  layer  is  .90  mm.  in  thickness  as 
compared  to  .60  mm.  in  the  above  mentioned  plate  of  the  normal 
brain.  Nerve  and  neuroglia  cell  counts  were  made  here  with  the 
result  that  an  average  of  59.91  nerve  cells  and  134.37  neuroglia 
cells  were  found  to  the  square  millimeter  of  surface  of  the  section 
as  compared  to  an  average  of  185.50  nerve  cells  and  109.20  neu- 
rogHa  cells  for  the  same  area  in  the  strip  of  cortex  represented  in 
Plate  VII,  Fig.  19,  of  the  corresponding  region  of  the  normal 
brain.  Both  sections  were  6  2-3  microns  in  thickness  and  both 
stained  with  methylene  blue.  The  difference  in  nerve  cells  is  very 
marked,  whereas  the  difference  in  number  of  neuroglia  cells  is 
not  so  great,  and  as  the  technique  was  identical  throughout  in 
the  preparation  of  the  two  sections,  the  marked  pathological  pro- 
cess shown  in  this  latter,  it  seems  to  the  writer  must  be  attributed 
as  the  cause  of  this  difference  to  a  large  extent  at  least. 

Parietal  Region. — Plate  XIV,  Fig.  42,  is  a  photomicrograph 
magnified  fourteen  diameters,  of  the  parietal  region  from  the 
point  H.  in  Plate  X,  Fig.  29,  this  being  a  part  of  the  supra-angu- 
lar gyrus  and  from  the  same  relative  part  of  the  gyrus  as  the 


I02 


G.  ALFRED  LAWRENCE. 


corresponding  plate  (VII,  Fig.  20)  of  the  normal  brain.  The 
section  was  fixed  in  95%  alcohol,  stained  with  methylene  violet, 
and  treated  otherwise  as  the  preceding  plates.  This  section 
measures  6  mm.  in  width,  16  mm.  in  length,  and  is  6  2-3  microns 
in  thickness.  Its  shape  is  long  and  narrow  and  quite  different 
from  that  of  Plate  VII,  Fig.  20.    At  the  vertex  of  the  convolution 


Plate  XIV,  Fig.  42. 


the  first  layer  has  geen  cut  away  with  the  paraffin  in  preparing  the 
block  for  sectioning  serially  with  a  Minot  microtome,  and,  of 
course,  this  condition  is  an  artefact.  The  first  layer  is  seen  to  be 
fairly  uniform  in  thickness  with  this  exception.  In  the  second 
layer  it  is  difficult  to  determine  the  well  marked  striated  arrange- 
ment of  the  cells,  as  seen  in  Plate  VII,  Fig.  20.  Numerous  peri- 
vascular and  pericellular  spaces  are  seen  with  or  without  the  capil- 


DEMENTIA  PARALYTICA.  IO3 

laries  or  cells,  as  the  case  may  be.  The  third  layer  is  indistinct 
and  fades  away  into  the  white  medullary  center  which  also  con- 
tains many  pericellular  and  perivascular  spaces.  No  doubt  the 
fixation  in  95%  alcohol  has  produced  some  shrinkage,  but  by  no 
means  all,  as  the  plates  of  the  occipital  convolution  just  posterior 
to  this  show  a  much  less  degree  of  shrinkage  than  is  here  present 
and  not  only  every  block  taken  from  this  brain  was  fixed  in  ex- 
actly the  same  way,  but  also  some  of  the  blocks  from  Brain  A. 
At  a  and  surrounded  by  ink  lines  is  the  segment  of  the  section 
shown  under  a  magnification  of  100  diameters  in  Plate  XIV, 
Fig.  43,  and  as  is  here  seen  is  taken  from  the  lateral  aspect  near 
the  vertex,  instead  of  from  the  vertex  as  in  the  corresponding 
plate  of  the  normal  cortex  (Plate  VH,  Fig.  21).  The  first  layer 
averages  .25  mm.  in  thickness  and  contains  numerous  capillaries 
with  thickened  walls,  and  tortuous  course  with  larger  and  smaller 
perivascular  spaces.  Numerous  neuroglia  cells  are  scattered 
throughout  this  layer.  The  second  layer  is  here  1.50  mm.  in 
thickness.  Here,  too,  are  seen  numerous  capillaries  with  thick- 
ened walls,  irregular  course,  and  large  perivascular  spaces.  In 
the  upper  half  of  the  layer  the  small  pyramidal  cells  gradually 
are  intermingled  with  larger  pyramidal  cells  as  the  lower  portions 
are  reached,  until  just  above  a  the  largest  pyramids  of  the  sec- 
tion are  seen  singly  or  in  groups  in  a  comparatively  narrow  zone. 
Below  and  opposite  a  is  a  narrow  zone,  some  .25  mm.  in  width 
in  which  there  are  practically  no  large  pyramidal  cells.  Below 
this  again  is  a  very  narrow  zone  at  the  lower  part  of  this  layer 
in  which  some  few  large  pyramidal  cells  are  seen  scattered  among 
the  smaller  and  irregular  cells.  These  cells  present  all  stages  of 
chromatolysis,  pigmentation,  shrinkage  of  the  cell-body  and  pro- 
cesses and  irregularity  in  direction  of  the  latter,  eccentricity  and 
shrinkage  of  the  nucleus  and  larger  and  smaller  pericellular 
spaces.  Numerous  neuroglia  cells  are  scattered  throughout  the 
layer.  The  third,  or  spindle  cell  layer,  measures  scarce  .50  mm, 
in  thickness  and  contains  for  the  most  part  shrunken  and  irregular 
spindle  cells  in  larger  or  smaller  pericellular  spaces,  in  many  in- 
stances in  various  stages  of  chromatolysis.  Numerous  neuroglia 
cells  in  many  cases  appearing  in  direct  contact  with  the  cell-body 
are  seen  in  this  layer,  as  well  as  in  the  above  layer.  The  vascular 
changes  are  also  similar.  The  entire  depth  of  the  cortex  here  is 
thus  2.25  mm.,  somewhat  less  than  in  Plate  VII.  Fig.  21,  but 
about  the  same  as  on  the  lateral  aspect  of  this  latter  plate.  Nerve 
and  neuroglia  cell  counts  were  made  here  in  the  same  manner 
as  in  previous  sections,  and  it  was  found  that  there  was  an  average 
of  68.63  nerve  cells  and  192.70  neuroglia  cells  to  each  square 
millimeter  of  surface  of  the  section  as  compared  to  104  nerve  cells 
and  180.90  neuroglia  cells  in  the  corresponding  region  of  Brain  A, 


I04 


G.  ALFRED  LAWRENCE. 


both  sections  being  of  the  same  thickness  and  stained  in  the  same 
manner  with  methylene  violet. 

Temporal  Region. — Turning  to  the  region  below  this  we  come 
to  the  temporal  region  represented  here  by  a  section  from  the 
first  temporal  convolution  near  its  anterior  extremity,   from  the 


!      J 


L-:^ 


Plate  XIV,  Fig.  44. 


point  /  in  Plate  X.  Fig.  29,  and  shown  under  a  magnification  of 
fourteen  diameters  in  Plate  XIV.  Fig.  44.  This  convolution  is 
also  much  narrower  than  the  corresponding  convolution  of  Brain 
A,  seen  in  Plate  VIII,  Fig.  22,  thus  having  a  somewhat  dissimilar 
mechanical  arrangement.  To  the  right  is  seen  the  first  temporal 
fissure  and  a  portion  of  the  second  temporal  convolution.  The 
convolution  measures  5.5  mm.  in  width  and  8  mm.  in  depth  from 


DEMENTIA  PARALYTICA.  105 

the  vertex  to  the  point  on  the  level  with  the  bottom  of  the  first 
temporal  fissure  and  is  6  2-3  microns  in  thickness.  The  convolu- 
tion at  this  point  is  seen  on  the  right  to  curve  around  and  fuse 
with  the  second  temporal  convolution,  being  free  above  at  h, 
which  is  the  lower  boundary  of  the  fissure  of  Sylvius  at  the  be- 
ginning of  the  posterior  branch.  At  a  and  enclosed  in  ink  lines 
is  the  segment  of  the  section  shown  in  the  following  plate  under 
a  magnification  of  100  diameters.  The  first  or  superficial  layer  is 
quite  uniform  in  thickness,  broken  in  several  places,  especially 
above  h  on  the  superior  surface.  The  second  layer  shows  the 
striated  arrangement  of  the  cells  only  very  indistinctly  at  some 
few  points  and  contains  many  pericellular  and  perivascular  spaces, 
some  with  and  others  without  contents.  The  third  layer  is  indis- 
tinct and  fades  into  the  white  medullary  center  which  is  narrow 
and  passes  inferiorly  over  to  connect  on  the  right  with  that  of  the 
second  temporal  convolution. 

In  Plate  XV,  Fig.  45,  strip  a  of  Plate  XIV,  Fig.  44,  under  a 
magnification  of  100  diameters,  the  pathological  conditions  are 
seen  to  be  well  marked.  The  section  is  6  2-3  microns  in  thick- 
ness and  stained  with  methylene  violet.  Here  the  first  layer  aver- 
ages about  .20  mm.  in  thickness  and  to  the  right  a  fragment  of  a 
blood  vessel  is  seen  at  the  surface,  but  penetrating  the  cortex  in 
a  different  plane.  In  the  center  and  reaching  into  the  second 
layer  is  a  large  capillary  with  thickened  walls,  with  larger  caliber 
above  and  smaller  below,  being  somewhat  funnel  shaped  and  sur- 
rounded by  a  large  perivascular  space.  Some  smaller  fragments 
of  capillaries  and  neurogha  cells  are  scattered  about  in  the  layer. 
The  second  or  pyramidal  cell  layer  is  1.50  mm.  in  thickness  and 
presents  very  much  the  same  general  plan  of  arrangement  as  the 
corresponding  region  in  the  normal  brain,  as  seen  in  Plate  VIII, 
Fig.  23,  and  also  in  the  region  of  the  first  frontal  convolution,  as 
seen  in  Plate  II,  Fig.  3,  and  XI,  Fig.  31.  Small  pyramidal  cells 
almost  exclusively  are  seen  in  the  upper  part  of  the  layer  below 
this  gradually  increasing  in  size  to  the  middle  of  the  layer.  Then 
opposite  a  is  a  narrow  strip  some  .20  mm.  in  thickness  in  which 
there  are  small  pyramidal  cells  almost  exclusively.  Below  this 
again  and  in  the  lower  part  of  this  layer  are  larger 
pyramidal  cells,  intermingled  with  smaller  pyramidal  and 
irregular  shaped  cells.  Here,  too,  the  majority  of  the  cells  are 
seen  shrunken  and  surrounded  by  larger  and  smaller  pericellular 
spaces.  Various  stages  of  chromatolysis,  shrinkage  and  eccen- 
tricity of  the  nucleus  and  atrophy  of  the  cell  processes  are  to  be 
observed.  The  blood  vessels  show  the  same  pathological  condi- 
tions as  in  the  upper  layer  and  numerous  neuroglia  cells  are  in- 
terspersed thickly  everywhere. 

The  third  layer  is  .80  mm.  in  thickness  and  presents  the  same 


io6 


G.  ALFRED  LAWRENCE. 


pathological  conditions  of  the  cells  and  blood  vessels  as  previously 
described  for  this  layer  in  Plate  XIV,  Fig.  43,  of  the  parietal 
region.  The  entire  depth  of  the  cortex  here  is  2.50  mm.,  some- 
what thicker  than  the  corresponding  region  of  Brain  A.  Nerve 
and  neuroolia  ceil  counts  were  also  made  here  and  in  a  similar 
manner,   an  average  of   56.74  nerve   cells  and   205.90  neuroglia 


Plate  XV,  Fig.  46. 


cells  being  found  to  the  scjuare  millimeter  of  surface  of  the  cor- 
tical portion  of  this  section,  as  compared  to  146.  nerve  cells  and 
131.90  neuroglia  cells  to  the  square  millimeter  of  the  surface  of 
the  cortex  in  the  corresponding  region  of  Brain  A.  In  the  latter 
methylene  blue  was  the  stain  used,  the  thickness  of  the  sections 
being  the  same  in  both  cases,  and  as  has  been  seen  in  every  in- 
stance the  metlnlene  violet  stain  has  greater  affinity  for  the  neu- 
roglia cells  than  the  methylene  blue,  whereas,  the  nerve  cells  stain 
about  the  san:e  with  the  one  as  with  the  other. 


DEMENTIA  PARALYTICA.  107 

Occipital  Region. — Plate  XV,  Fig.  46,  is  a  photomicrograph 
magnified  fourteen  diameters  of  a  section  taken  from  the  block  / 
of  Plate  X,  Fig.  29,  situated  in  the  upper  portion  of  the  lateral 
aspect  of  the  occipital  convolution.  The  section  is  5  mm.  wide, 
8  mm.  in  length  and  6  2-3  microns  in  thickness,  was  fixed  in  95% 
alcohol,  and  stained  with  methylene  violet.  As  may  be  observed, 
upon  the  posterior  aspect,  the  sulcus  is  very  shallow,  the  cortex 
here  fusing  with  that  of  the  adjacent  gyrus  not  far  from  the 
vertex,  whereas  anteriorly  the  sulcus  is  well  marked  and  quite 
deep.  The  first  or  outer  layer  is  thicker  both  on  the  posterior  and 
anterior  aspects  than  at  the  vertex  and  is  quite  uniformly  regular 
in  outline.  The  second  layer  is  well  marked  and  shows  the 
striated  arrangement  of  the  cells  quite  as  well  as  in  Brain  A,  at 
this  point.  Numerous  large  cells,  some  of  which  quite  approach 
the  Betz  cells  in  size  and  structure,  are  seen  scattered  in  the  middle 
and  lower  portions  of  the  layer.  The  third  or  spindle  cell  layer 
below  is  gradually  lost  in  the  white  medullary  substance.  Through- 
out the  entire  section  the  cells  and  their  arrangement  are  well 
made  out,  the  capillaries  although  having  thickened  walls  and 
somewhat  tortuous  are  less  conspicuous,  the  pericellular  spaces 
smaller  and  less  numerous,  and  most  of  the  cells  are  fairly  normal 
and  show  no  distinct  pathological  changes.  At  a  and  enclosed  in 
ink  lines  is  the  position  of  the  segment  in  the  adjacent  section 
from  which  Plate  XV,  Fig.  47,  was  taken.  This  latter  corre- 
sponds most  favorably  with  Plate  IX,  Fig.  25,  from  the  corre- 
sponding region  of  the  normal  brain  and  some  of  the  nerve  cells 
here  in  Plate  XV,  Fig.  47,  are  larger  and  more  numerous  than 
in  the  corresponding  section  from  Brain  A.  The  first  or  outer 
layer  is  uniform  in  outline  and  measures  here  but  .15  mm.  in 
thickness.  It  contains  numerous  neuroglia  cells  and  some  scat- 
tered small  nerve  cells  similar  to  those  described  in  Plate  II,  Fig. 
3,  and  seen  in  the  text  as  Figs.  C,  D,  E,  and  F.  The  second  or 
pyramidal  cell  layer  is  of  special  interest  and  measures  1.40  mm. 
in  thickness,  being  somewhat  deeper  than  in  Plate  IX,  Fig.  25, 
but  with  a  similar  arrangement  of  cells.  Above  are  small  pyra- 
midal cells  only,  then  larger  pyramidal  cells  are  seen  in  the  deeper 
portions  until  about  the  middle  of  the  layer  is  a  region  containing 
very  large  pyramidal  cells,  same  as  the  one  indicated  by  the 
letter  X,  for  instance,  being  similar  in  size  and  structure  to  the 
Betz  cells.  Below  this  at  a  is  a  region  .30  mm.  in  thickness  in 
which  numerous  small  pyramidal  cells  are  alone  seen.  Below  this 
again  is  a  narrow  zone  containing  some  larger  pyramidal  cells 
scattered  amongst  the  small  pyramidal  and  irregular  cells.  The 
cell  marked  in  the  plate  by  the  letter  X  is  seen  magnified  in  Fig. 
X,  It  is  very  large,  contains  irregularly  elongated  and  linear 
chromophilic  bodies  of  considerable  size  and  arrangement  in  a 


I08  G.  ALFRED  LAWRENCE. 

more  or  less  parallel  direction  to  the  cell-body  and  extending  into 
the  dendritic  processes.  The  nucleus  is  large,  rounded,  distinct, 
and  centrally  located  with  a  distinct  rounded  nucleolus  and  inde- 
finite chromophilic  network  within.  No  processes  are  given  off 
at  the  base  in  this  plane,  but  a  large  process  is  given  off  upon  the 
right  at  the  level  of  the  nucleus  and  soon  divides  into  two 
branches.  Another  process  is  given  off  to  the  left  on  the  oppo- 
site side  of  the  cell -body  at  a  level  just  above  the  nucleus.  The 
apical  dendric  process  contains  numerous  linear  chromophilic 
bodies  extending  for  some  distance  into  the  same.  This  is  a 
stichochrome  nerve  cell  of  the  somatochrome  class,  and,  in  size 
and  structure,  is  similar  to  the  Betz  cell.  The  two  cells  to  the 
extreme  right  are  similar  in  structure  but  not  as  large  as  the 
above.  There  are  no  pathological  changes  to  be  determined  in 
the  cells  of  this  layer.  Several  small  capillaries  are  seen  with 
somewhat  thickened  walls,  indicating  that  possibly  the  blood  ves- 
sel changes  are  the  first  to  be  found  in  the  disease,  but  of  course 
much  more  extended  observation  and  study  would  be  required 
to  determine  the  full  relation  of  all  these  pathological  processes 
to  one  another.  The  third  or  spindle  cell  layer  is  here  .90  mm.  in 
thickness  and  made  up  of  spindle  and  irregular  polygonal  cells, 
quite  normal  in  appearance  for  the  most  part;  some,  however, 
showing  slight' shrinkage,  pericellular  spaces,  and  slight  begin- 
ning chromatolysis.  Some  capillaries  with  thickened  walls  and 
perivascular  spaces  are  to  be  observed  here  also.  The  entire  thick- 
ness of  the  cortex  measures  2.45  mm.  being  .45  mm.  thicker  than 
in  Plate  IX,  Fig.  25.  Nerve  and  neuroglia  cell  counts  were  made 
here  with  the  results  that  62.50  nerve  cells  and  215.01  neuroglia 
cells  were  found  on  an  average  to  each  square  millimeter  of  sur- 
face of  the  cortex  here,  as  compared  to  164.  nerve  cells  and  199. 
neuroglia  cells  in  the  same  area  of  the  corresponding  section  of 
Brain  A,  both  sections  being  6  2-3  microns  in  thickness  and 
stained  with  methylene  violet.  From  a  study  of  the  above  plates 
from  these  two  brains,  the  cortex  in  Brain  A,  would  seem  to  be 
thinner  and  more  compact,  whereas,  the  cortex  of  Brain  B,  on  an 
average  measures  somewhat  thicker,  yet  the  cells  seem  more 
scattered,  so  that  a  very  much  higher  average  of  nerve  cells  is  to 
be  found  in  the  former,  far  more  it  seems  to  the  writer  than  could 
be  accounted  for  by  the  possible  destruction  of  some  of  the  cells 
in  the  sections  of  Brain  B,  due  to  pathological  agencies. 

The  careful  detailed  study  of  the  sections  from  various  parts 
of  the  different  regions  of  Brain  A,  practically  normal  from  a 
histological  standpoint,  and  of  corresponding  sections  of  Brain  B, 
a  case  of  advanced  dementia  paralytica  in  the  manner  as  described 


DEMENTIA  PARALYTICA.  109 

in  this  article  has  led  the  writer  to  the  following  conclusions : 
I.  Photomicrography  is  a  useful  and  valuable  adjunct  to  such 
work,  giving  greater  accuracy  in  relations  of  parts  to  one  another 
than  is  possible  in  drawings  and  showing  conditions  as  they  actu- 
ally appear  to  the  eye  of  the  observer  in  each  particular  plane 
when  the  sections  are  seen  under  the  microscope.  Powers  of  14 
or  20  diameters  show  very  well  relations  of  the  layers  to  one 
another,  and  also  the  relation  of  the  groups  of  large  cells ;  such  as 
the  Betz  cells  in  the  central  regions,  for  instance.  Powers  of  100 
diameters  are  well  adapted  to  the  study  of  the  more  minute  detail 
of  these  relations  of  the  layers  and  of  various  cells  to  one  another, 
and  also  some  of  the  morphology  of  the  individual  cells  can  be 
made  out.  Powers  of  1,000  to  1,500  diameters  show  the  internal 
structure  of  the  cell  to  excellent  advantage,  but  only  in  the  very 
limited  plane  at  which  the  object  is  focussed.  On  the  other  hand, 
the  disadvantage  of  photomicrography  is  that  everything  is  shown 
in  any  one  plane  so  that  special  parts  or  structures  are  not  brought 
out  as  prominently  as  in  schematic  drawings,  and  on  this  account 
all  such  work  should  be  accompanied  by  such  drawings  to  make  it 
more  complete.  It  is  furthermore  often  quite  difficult  to  obtain 
any  one  plane  showing  most  of  the  cell  structure,  to  say  nothing 
of  all  of  the  same. 

II.  Artefacts  of  many  kinds  are  to  be  found  in  such  work,  and 
should  be  carefully  avoided  and  eliminated  in  every  instance  be- 
fore definite  conclusions  are  drawn  from  any  series  of  observa- 
tions. Pressure  and  other  mechanical  causes  acting  before  death, 
that  due  to  manipulation  at  autopsy,  artefacts  resulting  from  fixa- 
tion, imbedding,  sectioning,  staining,  decolorizing,  and  even 
mounting,  are  all  possibilities,  and  are  often  most  difficult  to  deter- 
mine in  contradistinction  to  the  pathological  changes. 

III.  The  method  of  transporting-  material  by  means  of  small 
metallic  boxes  or  similarly  sized  phials,  permitting  of  a  free  cir- 
culation of  various  kinds  of  fixative  fluids,  without  injury,  and 
also  permitting  of  subsequent  exact  localization,  the  process  re- 
quiring a  minimum  of  time  and  space  is,  to  the  mind  of  the  writer, 
of  decided  practical  value  in  such  work.  This  method  is  fully 
described  in  the  text  under  the  heading  of  "Technique." 

IV.  Nerve  and  neuroglia  cell   counts  have  been  alluded  to 


no  G.  ALFRED  LAWRENCE. 

above,  but  a  few  remarks  upon  method  may  be  of  value.  The 
method  of  counting  the  same  from  photomicrographs  of  moderate 
magnification  is  not  accurate,  as  cells  may  overlap  or  be  arranged 
in  dense  groups  or  their  images  may  not  all  be  sufficiently  distinct 
so  as  to  differentiate  them  properly,  especially  does  this  apply  to 
the  neuroglia  cells,  which  are  very  small  and  often  closely  aggre- 
gated. Photomicrographs  magnified  a  thousand  diameters  or 
more,  although  showing  all  the  cells  visible,  are  much  too  limited 
in  area.  For  these  reasons  the  use  of  the  ocular  net-micrometer 
was  found  to  be  the  best  and  most  accurate  for  this  work,  using 
a  stage  micrometer  to  determine  the  relation  of  the  ocular  field  to 
the  actual  size  of  the  section.  In  this  way  the  exact  number  of 
nerve  and  neuroglia  cells  can  be  determined  for -any  number  of 
fields  and  an  average  obtained  for  any  area,  as  was  done  in  vari- 
ous plates  in  the  brains  employed  in  this  work,  as  seen  in  Table  II. 
As  will  be  noted  by  referring  to  this  latter,  there  is  considerable 
variability  in  ihe  number  of  nerve  and  neuroglia  cells  not  only  in 
different  cortical  regions  but  also  from  adjacent  sections  of  the 
same  region.  The  stain  is  seen  to  play  an  important  role  here 
in  the  resulting  average  number  of  neuroglia  cells,  methylene 
violet  having  a  greater  affinity  for  these  cells  than  methylene  blue. 
Sections  stained  by  the  latter  cannot  always  be  depended  upon  to 
show  all  the  neuroglia  cells.  In  comparing  the  normal  paretic 
brain  there  is  marked  diminution  of  the  nerve  cells  in  the  latter  as 
compared  to  the  former,  whereas  the  neuroglia  cells,  making  due 
allowance  for  variability,  are  somewhat  increased  in  number  in 
the  paretic  brain. 

V.  The  thickness  of  the  layers  is  not  constant  in  different 
parts  of  the  same  gyrus,  nor  even  in  different  portions  of  a  single 
transverse  section  of  a  gyrus,  to  say  nothing  of  different  regions 
of  the  cortex.  In  the  same  way  there  is  greater  or  less  variability 
in  the  shape  and  mechanical  arrangement  of  each  gyrus  in  con- 
trast to  the  other  gyri  making  up  the  surface  of  the  hemisphere 
and  different  parts  of  the  same  gyrus  vary  in  this  respect.  This 
will  be  best  observed  by  referring  to  the  several  plates  of  both 
Brains  A  and  B,  magnified  14  diam.eters,  and  of  the  various 
regions  of  the  cortex. 

VI.  After  a  quite  extended  perusal  of  the  literature  upon  the 


DEMENTIA  PARALYTICA.  ill 

structure  of  the  cortex  as  presented  in  the  first  portion  of  this 
article,  the  writer  incHnes  to  the  view  of  a  three-layered  type  of 
cell  arrangement  in  the  cortex,  as  the  type  with,  of  course,  varia- 
tions in  special  parts,  as  the  cornu  ammonis,  for  instance.  This  is 
shown  in  Table  I,  and  brief  is  as  follows:  i,  or  superficial  layer, 
containing-  but  few  nerve  cells,  many  neuroglia  cells,  and  many 
chiefly  tangential  fibers.  The  first  two  elements  only  are  seen 
with  the  Nissl  stain,  whereas  the  latter  element  is  most  conspicu- 
ous with  Weigert's  stain,  and  for  this  latter  reason  Ramon  y  Cajal 
designated  it  as  the  tangential  fiber  layer ;  2,  or  pyramidal  cell 
layer,  to  reduce  the  layering  of  the  cortex  to  its  lowest  terms,  and 
including  the  small,  large,  and  giant  or  Betz  pyramidal  cells  all  in 
this  one  layer ;  3,  or  spindle  cell  layer,  including  both  the  spindle 
cells  which  are  in  the  majority  and  the  less  numerous  irregular 
pol3^gonal  cells.  Below  these  three  layers  is  the  sub-cortical  white 
medullary  substance. 

VII.  The  study  of  the  internal  structure  of  the  normal  brain 
from  a  histological  standpoint  (Brain  A)  by  the  Nissl  method 
shows  four  principal  types  of  nerve  cells :  ( i )  The  small  rounded 
nerve  cells  of  the  first  layer  with  or  without  one  or  more  dendritic 
processes — rarely  more  than  two,  containing  a  rounded  nucleus 
almost  fillmg  the  body  of  the  cell,  this  latter  surrounded  by  a 
partial  or  complete  narrow  band  of  finely  granular  chromophilic 
substance.  The  neucleus  contains  a  well  marked  neucleolus  and 
slightl}'  stained  protoplasmic  substance.  These  are  co-called  kar- 
yochrome  nerve  cells  of  Nissl's  classification.  (2)  The  pyramidal 
cells  of  the  second  layer,  of  which  there  are  four  varieties  (a)  the 
small  pyramidal  cells,  (b)  the  large  pyramidal  cells,  (c)  cells  in- 
termediate in  size  and  structure  between  the  large  pyramidal  cells 
and  the  typical  giant  pyramidal  or  "Betz"  cells,  and  (d)  the  giant 
pyramidal  or  "Betz"  cells.  In  the  smaller  pyramidal  cells  it  is 
difficult  to  distinguish  distinct  chromophilic  granules,  but  the 
chromatin  is  arranged  in  larger  or  smaller  finely  granular  masses 
in  various  parts  of  the  cell-bod}^  sometimes  aggregated  about  the 
nucleus,  at  other  times  near  the  base  or  dendritic  processes.  The 
larger  pyramidal  cells,  however,  have  the  increasing  amount  of 
chromatic  substance  arranged  in  more  or  less-  distinct  larger  and 
smaller  chromophilic  granules,  and  these  arranged  in  a  direction 


112  G.  ALFRED  LAWRENCE. 

parallel  to  the  surface  of  the  cell-body.  Still  larger  in  size  and 
more  distinct  in  the  arrangement  of  chromophilic  granules  in  this 
general  parallel  manner  are  the  intermediate  variety  of  these 
pyramidal  cells,  which,  although  larger  than  the  average  pyramidal 
cell  are  considerably  smaller  than  the  typical  Betz  cell,  and  have 
a  wider  range  of  distribution  not  only  in  the  vertical  extent  of  the 
second  layer  of  the  cortex,  but  also  in  the  different  regions  of  the 
cortex,  being  found  in  the  central,  parietal,  temporal,  and  occipital 
regions.  Finally  the  largest  in  size  and  most  distinct  in  structure, 
especially  in  the  arrangement  of  the  chromatic  substance,  are  the 
giant' pyramidal  or  Betz  cells,  in  which  larger  size,  large  distinct 
nucleus  and  nucleolus,  and  also  large  parallel  arranged  chro- 
mophilic granules  are  seen  in  the  cell-body,  and  often  extending 
far  up  into  the  dendritic  processes.  These  are  localized,  for  the 
most  part,  in  the  lower  portion  of  the  second  layer  in  certain  areas 
of  the  central  convolution  and  the  posterior  portion  of  the  superior 
frontal  convolutions.  These  pyramidal  cells  as  a  whole  can  best 
be  designated  as  stichochromc  nerve  cells  of  the  somatochrome 
class  in  Nissl's  classification,  although  the  smaller  pyramidal  cells 
may  simulate  more  the  gryochrome  nerve  cells  of  this  same  class, 
owing  to  the  indistinct  arrangement  of  the  chromatic  -substance. 

(3)  The  spindle  cells  found  in  the  third  layer  and  containing  a 
very  large  nucleus  with  well  marked  nucleolus.  The  nucleus  is 
often  so  large  that  it  seems  disproportionate  to  the  size  of  the 
latter.  The  chromatic  substance  here  is  finely  granular  and  ar- 
ranged in  irregular  masses  or  heaps  about  the  nucleus,  and  ex- 
tending into  the  base  of  the  dendritic  processes,  these  latter,  usu- 
ally two  in  number  and  opposite,  producing  a  bipolar  condition. 
These  cells  are  gryochrome  nerve  cells  of  the  somatochrome  class. 

(4)  Finally  irregular  or  polygonal  nerve  cells  are  found  in  the 
second  and  third  layers.  These  cells  are  irregular  in  shape,  with 
three  or  more  dendritic  processes,  a  large  nucleus  containing  a 
well  marked  nucleolus.  In  the  cell-body  are  irregular  finely 
granular  masses  of  chromatic  substance  similar  to  the  spindle  cells 
in  this  respect,  so  could  fall  in  the  same  classification  as  gryo- 
chrome nerve  cells  of  the  somatochrome  class.  In  the  cerebellum, 
the  Purkinje  cells,  with  their  chromatic  substance  more  or  less 
arranged  in  a  network,  are  classified  as  arkychrome  nerve  cells  of 


DEMENTIA  PARALYTICA.  II3 

the  soniatochronie  class,  whereas  the  small  nerve  cells  of  the  granu- 
lar layer,  with  small  nucleus,  appear  only  partially  surrounded  by 
the  cell-body,  are  classified  as  cytochrome  nerve  cells.  The  four 
types  of  cells  above  mentioned,  as  found  in  the  cerebral  cortex, 
were  seen  in  all  the  regions  of  the  external  surface  of  the  hemi- 
sphere studied.  In  addition  to  these  cellular  elements  of  the  nerv- 
ous tissue  the  neuroglia  cells  of  the  interstitial  tissue  were  every- 
where to  be  seen,  and  in  the  walls  of  the  blood  vessels  the  vascular 
cellular  elements  were  also  to  be  found. 

VIII.  Previous  investigators,  in  the  study  of  the  cerebral  cor- 
tex in  dementia  paralytica  by  the  use  of  the  Nissl  method,  have 
noted  the  following  pathological  changes :  Various  stages  of  cell 
degeneration  up  to  complete  destruction  of  the  same,  consisting  of 
diminution,  disintegration,  and  vacuolization  of  the  cell  proto- 
plasm, all  stages  of  chromatolysis  up  to  complete  disappearance 
of  the  chromatic  substance,  shrinkage  with  deformity  of  the  con- 
tour of  the  cell-body,  atrophy  of  the  dendritic  processes,  various 
degrees  of  pigmentation  and  pigmentary  deposits  in  the  cell-body, 
also  adjacent  to  blood  vessels;  shrinkage  with  diminution  in  size, 
irregularity,  compression,  vacuolization,  and  eccentricity  of  the 
nucleus  with  even  extrusion  of  the  same  from  the  cell-body  by  the 
rupture  of  the  cell  wall,  or  complete  sclerosis  of  the  nucleus  with 
homogeneous  and  tinged  contents  or  crystalline  deposits,  nucleolus 
displaced  to  nuclear  wall  or  indistinguishable  or  vacuolated,  cal- 
careous deposits  in  the  form  of  fine  granules,  crumbs,  placques,  or 
stalactitic  masses  intensely  colored  with  methylene  blue  and  found 
in  the  bodies  of  the  sclerosed  cells,  part  or  whole  of  cell  entirely 
bleached,  complete  necrosis  of  cells,  reduction  in  number  of  nerve 
cells,  thickening  of  pia  with  septa  projecting  into  the  cortex, 
granular  crowding  of  variously  stained  granules,  obscure  layering 
of  the  cortex,  multiplication  of  white  corpuscles,  proliferation  of 
neuroglia  cells,  increase  in  and  dilatation  of  capillaries  and  arteri- 
oles, with  thickening  of  walls  of  same  by  encasement  of  latter  with 
lymphatic  corpuscles,  and  finally  proliferation  of  interstitial  net- 
work. The  writer  has  observed  all  of  these  changes  excepting 
the  following:  vacuolization  of  the  cell  protoplasm  was  not  ob- 
served in  the  paretic  material  examined  in  this  work,  no  pigment- 
ary deposits  were  observed  outside  of  the  nerve  cell  bodies,  al- 


1 14  G.  ALFRED  LAWRENCE. 

though  varying  amounts  were  found  in  many  of  the  nerve  cells. 
No  vacuolization  of  the  nucleus  or  extrusion  of  the  same  was 
found  here,  no  crystalline  or  calcareous  deposits  were  made  out 
in  any  of  the  cells,  no  septa  were  observed  penetrating  from  the 
thickened  pia  into  the  cortex,  multiplication  of  white  corpuscles 
was  not  observed,  and  proliferation  of  neuroglia  cells  as  seen  from 
the  nerve  and  neuroglia  cell  counts  as  tabulated  in  Table  11. 
seems  to  have  existed  to  but  a  slight  extent  in  small  localized 
places,  as  about  some  of  the  necrosed  nerve  cells.  The  writer 
does  not  mean  to  say  that  this  may  not  occur  in  some  cases,  for 
on  the  contrary  he  is  inclined  to  think  it  may  occur  under  certain 
conditions,  either  localized  or  more  general.  Also  no  prolifera- 
tion of  the  interstitial  network  was  observed  here.  About  the 
nerve  cells  pericellular  spaces  of  greater  or  less  extent  were  ob- 
served in  many  cases.  In  some  only  a  small  portion  of  the  cell- 
body,  or  a  single  dendritic  process,  was  surrounded  by  a  limited 
space ;  in  many,  however,  a  large  portion  of  all  the  cell-body  was 
thus  surrounded.  Perivascular  spaces  were  also  observed  of 
varying  size  and  extent  about  many  of  the  blood  vessels  of  the 
cortex.  Pigmentation,  in  addition  to  being  present  in  many  of 
the  nerve  cells  of  the  first  and  second  layers  of  the  cortex  in  the 
central  regions,  was  also  observed  in  cells  of  these  layers  in  the 
frontal  region  as  well ;  also  in  the  parietal  and  temporal  regions, 
but  not  in  the  occipital  region.  The  pathological  process  here 
was  most  severe  in  the  central  and  frontal  regions,  extending  to  a 
lesser  extent,  but  still  very  marked,  into  the  temporal  and  parietal 
regions,  whereas  the  occipital  region  almost  entirely  escaped  and 
appears  practically  normal.  In  the  regions  involved  in  this  case 
the  disease  seems  to  be  a  chronic  disease  of  the  nerve  cells  with 
pigmentary  degeneration  and  a  necrosis  of  the  cell-body,  partial 
or  complete,  with  accompanying  involvement  of  the  blood  vessels. 
The  relation  of  the  vascular  and  cell  changes  to  one  another  and 
the  order  of  procedure  in  time  is  one  that  the  writer  believes  re- 
quires much  more  extended  investigation  before  it  can  be  answered 
satisfactorily. 

In  conclusion  the  writer  gratefully  acknowledges  the  kindly 
interest,  suggestions,  and  assistance  offered  by  Professor  H.  Fair- 
field Osborn,  Professor  Bashford  Dean,  Dr.  Oliver  S.  Strong, 
and  Dr.  Edward  Leaming,  of  Columbia  University;  Dr.  Ira  Van 


9«nnari 
1782 

Vlcq  d'Azyr 
1786 

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DEMENTIA  PARAL YTICA.  1 1 5 

Giesen,  former  Director  of  the  New  York  State  Pathological  Insti- 
tute; Dr.  H.  T.  Brooks,  Professor  of  Histology  and  Pathology 
at  the  New  York  Post-Graduate  Medical  School,  and  Hospital; 
Dr.  Philip  F.  O'Hanlon,  Coroner's  Physician,  New  York  City,  and 
Dr.  Robert  T.  Irvine,  of  Ossining,  N.  Y. 

LITERATURE. 

Anglade,  D.  "Sur  les  alterationes  des  cellules  nerveuses  de  la  cellule 
pyramidale  in  particular  dans  la  paralysie  generale."  Annales  Medico- 
Psychologiques.  Huitieme  Serie,  Tome  Huitieme,  Sinquante  sixieme  Annee 
(1898),  p.  40. 

Arndt,  R.  "Untersuchungen  iiber  die  ganglion-Korper  des  Nerves 
sympathicus."  Arch.  f.  mikr.  Anat.  Bonn.  Bd.  X.  (1874),  S.  208-241. 

Baillarger,  J.  "Recherches  sur  la  structur  de  la  couche  corticale  des 
circonvolutions  du  cerveau."  (1840).  Annales  Med.-Psychol.  (1855).  I.,  1-3. 
"De  ridiotie."  Gaz.  des  hop.  (185^).  No.  84  Canst.  Jahresber.  (1855). 
III.,  p.  8,  Mem.  de  I'Acad.  de  Med.,  (1880).  VIII.  Bull,  de  I'Acad.  de 
Med.  (1856,  Juillet).  Gaz.  habdom.  (1859).  (Cit,  Griesinger,  p.  366). 
Acad,  de  Med.  (Cit.  Griesinger,  p.  360).  Annal  Med.-Psychol.,  1882,  VII. 
I,  p.  19.  Baillarger  et  Gratiolet.  Acad,  de  Med.  (May  26,  1857)  (Cit. 
Griesinger). 

Ballet,  Gilbert.  "Les  Lesions  cerebrales  de  la  paralysie  generale 
etudiees  par  la  methode  de  Nissl."  Ann.  Med.  psychol.  Par.  8.  s.  t.  VII 
(1898),  pp.  448-459- 

Barker,  L.  T.     "The  Nervous  System  and  Its  Constituent  Neurones. 
D.  Appleton  &  Co.,  N.  Y.,  1899. 

Belmondo,  F.  "Alterazione  dei  centri  nervosi  nella  paralisi  progres- 
siva."   Annali  di  Neurolgia  (1896).    p.  475. 

Berger,  H.  "Degeneration  du  Vorderhornzellen  des  Ruckenmarks 
bei  Dementia  paralytica."     Monatschrift  f.  Psych,  u.  Neur.    (1898),  H.  I. 

Berlin,  R.  "Beitrage  sur  .Structurlehre  d.  Grosshirnwindungen."  Er- 
langer   (1858). 

Benda,  C.  "Ueber  die  Bedeutung  der  durch  basiche  Anilinfarben  dar- 
stellbaren    Nervenzellstructuren."     'Neurol.    Centralbl.      Leipz.    Bd.    XIV, 

(1895),  s.  759-768. 

Betz,  W.  "Ueber  die  feinen  Structur  d.  Menschl.  Gehirnrinde.  Med. 
Centralbl.  (1881).  Centralbl.  f.  d.  Med.  Wissensch.  (1881).  N.  r.  11-13. 
Centralbl.  f.  d.  Med.  Wissensch.    (1874).  N.  37-38. 

Boedecker  and  Juliusberger.  "Anatomische  Befunde  bei  Dementia 
paralytica."    Neur.  Cent.  (1897),  p.  774- 

Boll,  F.  "Die  Histiologie  und  Histiogenese  der  nervosen  Central- 
organe."     Archiv.  f.  Psych.  (1873),  IV,  pp.  1-38. 

Cajal,  S.  Ramon  y.  "Les  nouvelles  idces  sur  la  Structure  du  systeme 
nerveux  chez  I'homme  et  chez  les  vertebres."     (1895.) 

Charcot,  J.  M.  "Anatomic  Pathologique."  Le  Progres  Medical,  p. 
253   (1871). 

Clarke,  L.  "Notes  on  Researches  on  the  Intimate  Structure  of  the 
Brain."     Proc.  Royal  Society  of  London,  Vol.  XII,  p.  716  (1863). 

Cleland,  John.     "Human  Anatomy,  General  and  Descriptive."     p.  627 

(1876).  ... 

Crisafulli,    E.      "Studio    comparative    clinico    istologico    sulla    paralisi 

generale  progressiva."  Ann.  di  Neurolog.  14,  p.  255.     Also:  Ulteriore  con- 


Il6  G.  ALFRED  LAWRENCE. 

tribute  alia  istologia  path,  della  paralisi  generale  progressiva."  Annali  di 
Neurolog.   (1897),  p.  194. 

De  Quervain,  Fritz.  "Ueber  die  Veranderungen  des  Central  nerven- 
systems  bei  experimentellen  Kachexia  thyreoidea  der  Thiere."  Arch.  f. 
path.  Anat.  etc.,  Berl.  Bd.  CXXXIII  (1893),  S.  481. 

Dogiel,  A.  S.  "Zur  Frage  iiber  den  Bau  der  Nervenzellen  und  iiber 
des  Verhaltniss  ihres  Achencylinder  (Nerven)  Fortsatzes  zu  den  Proto- 
plasmsfortsatzen  (Dendriton)."  Arch.  f.  mikr.  Anat,  Bonn.  Bd.  XLI 
(1893),  S.  62-87.  Also:  "Zur  Frage  iiber  des  Verhalten  der  Nervenzellen 
zu  einander.  Arch.  f.  Anat.  u.  Physiol.  Anat.  Abth.  Leipz.  (1893),  S. 
429-434- 

Donaldson,  H.  H.  "The  Size  of  Several  Cranial  'Nerves  in  Man  as 
Indicated  by  the  Areas  of  their  Cross-sections."  Amer.  Jour,  of  Psychol.', 

4,  1891-1892,  p.  227. 

Edinger,  L.  "Anatomy  of  the  Central  Nervous  System  in  Man  and 
in  Vertebrates  in  General."     (1896.) 

Ewing,  James  T.  "Studies  on  Ganglion  Cells."  Archiv.  of  Neurol, 
and  Psychopath.,  Vol.  I,  No.  3  (1898). 

Flemming,  W.  "Beitrage  zur  Anat.  u.  Embryol.  als  Festgabe  fur  J. 
Henle,"  (1882),  Bonn.  S.  12. 

Cf.  also,  "Ueber  den  Bau  der  Spinalganglienzellen  bei  Saugethieren, 
und  ■  Bemerkungen  iiber  den  centrallen  Zellen."  Arch.  f.  mikr.  Anat., 
Bonn.  1895.  Bd.  XLVI,  S.  379-394,  and,  "Die  Struktur  der  Spinalgan- 
glienzellen bei  Saugetieren.  Arch.  f.  Psychiat.  u.  Nervenkr.,  Berl.  Bd. 
XXIX  (1897),  H.  3.  S.  969-974.  . 

"Ueber  die  Sti-uktur  centrallen  'Nervenzellen  bei  Wirbeltieren."  Anat. 
Hefte,  I.  Abth.,  19.  Heft.    (1896)    (Bd.  VI,  H.   19,  p.  561). 

Flesch,  M.  "Ueber  Verschiedenheiten  im  chemischen  Verhalten  der 
Nervenzellen."    Mitth.  d.  Naturf.  Gesellsch.  in  Bern   (1897)   M.  1169-1194, 

5.  192-199-     Bern.  P.  Haller  (1888). 

Gennari,  Francisco.  "De  peculiaris  structura  cerebri,  non-nulisque 
ejus  morbis.  Pancae  aliae  anatom.  observat.  accedunt."  XVI,  pp.  87,  4rfc. 
"Pannae  ex  regis  typg."   (1782.) 

Golgi,  C.  "Sulla  fina  Anatomia  Organi  Centrali  del  Sistema  Nervosa." 
(1885.)     p.  65.     Archiv.  ital.  de  Biol.   (1883.)     Ref. 

Gowers,  W.  R.     "Diseases  of  the  'Nervous   System."     Vol.  II,  p.   lO 

(^893)- 

Hammarberg,  Carl.  "Studien  iiber  Klinik  und  Pathologie  die  Idiotic 
nebst  Untersuchungen  iiber  die  Normale  Anatomic  der  Hirnrinde."(i895.) 

Henle,  J.   "Anatomic,"   2nd   Ed.   Vol.    II,   p.   306    (1876). 

Jelliffe,  Smith  Ely.  "Biographical  Contribution  to  the  Cytology  of 
the  Nerve  Cell."  Arch,  of  Neurology  and  Psychopathology.  Vol.  I,  No. 
3  (1898),  p.  441- 
Key,  E.  A.  H.,  and  Retzius,  G.  "Studien  in  der  Anatomic  des  Nerven- 
systems  und  des  Bindegewebes."     4to.   Stockholm    (1876). 

Kolliker,  A.  "Mikroskopische  Anatomic."  Band  II  (1830).  "Hand- 
buch  der  Gewebelehre."     Leipzig  (1867). 

Krause,  W.     "Anatomic."     Vol.  I,  p.  439   (1876). 

Lewis,  Bevan.  "Comparative  Structure  of  the  Cortex  Cerebri."  Med. 
Times  and  Gaz.  (1876,  Mar.  4).  Brain  (t868).  Vol.  I.  Philosophy. 
Transact.  (1880).  Lewis  and  Clarke.  "On  the  Cortical  Lamination  of 
the  Motor  Area  of  the  Brain."  Proc.  of  the  Royal  Soc.  of  London  (1878). 
Vol.  27,  p.  38. 

Luys,  J.     "Systeme  Nerveux,"  p.  ,162  (1864). 

Major,  H.  C.  "The  Histology  of  the  Island  of  Reil."  West  Riding 
Lunatic  Asylum  Medical  Reports.    Vol.  VI  (1876),  p.  5. 

Meckel,  J.  F.     "Anatomic."     Vol.  II,  p.  443. 


DEM  EXT  I A  PARA  L  VTICA.  1 1 7 

Meynert,  T.  "Der  Bau  der  Grosshirnrinde  und  seine  ortlichen  Ver- 
schiedenheiten  nebst  einem  pathol.  anat."  Vierteljahrschr.  f.  Psychiatrie 
von  Leidesdorf  und  Meynert  (1867).  u.  (1868).  "Corallium,"  Leipzig 
(1872),  und  Strieker's  Handbuch  (1871).  Allg.  Wiener  med.  Ztg.  (1868), 
XIII,  Psychiatry,  translated  by  Sachs,  B.  (1885). 

Nagy,  A.  "An  ag'yking  idigsijtjunek  elvatozasarol  ehnebautalmaknae." 
Maggae  Arvosi  Archivum  (1894). 

"Ueber  die  Veranderurgen  der  Hirnrindenzellen  bei  Psychosen."  Neur. 
Cent.  (1894),  p.  820. 

Nissl,  Franz.  (a)  "Ueber  die  Untersuchungsmethoden  der  gross 
himrinde."  Tagebl.  d.  58,  Versamml.  Deutsch.  naturf.  u.  aerzte  in 
Strassburg   (1885),  S.  506.' 

(b)  "Ueber  den  Zusammenhang  von  Zellstruktur  und  Zellfunktion." 
Tagebl.  de  61  Versamml.  Deutsch.  naturf.  u.  aerzte  in  Koln  (1888).  Inter. 
Klin.  Rundschau.    II  (1888).     No.  43. 

(c)  "Die  Kern  d.  Thalamus  beim  Kaninchen."  Tagebl.  d.  Naturforsch. 
V.  2.   Heidelberg   (1890),  S.  509.  _     "      "=!,"! 

(d)  "Ueber  die  Veranderungen  der  Ganglienzellen  in  Facialis  Kiern 
des  Kaninchens  nach  ausreissung  der  Nerven."  Allg.  Ztschrift.  f.  Psych. 
Bd.  XLVIII   (1891-92),  S.  197. 

(e)  "Ueber  experimentell  erzeugte  Veranderungen  an  den  Vorder- 
hornzellen  des  Riickenmarkes  bei  Kanincheri  mit  Demonstration  mik- 
roskopische  Praparate."  Allg.  Ztschr.  f.  Psychiat.  Bd.  XLVIII  (1891- 
92),  S.  675-682. 

(f)  "Mittheilungen  zur  Anatomic  der  Nervenzelle."  Allg.  Ztschrft. 
f.  Psychiatrie.  Bd.  L.  (1894),  S.  370. 

(g)  "Ueber  Rosin's  neue  Farbemethode  des  gesammten  Nervensys- 
tems  und  dessen  Bemerkungen  iiber  Ganglienzellen."  Neurolog.  Central- 
blatt,  XIII   (1894),  S.  96-141. 

(h)  "Ueber  eine  neue  Untersuchungsmethode  des  Centralorganes 
speziell  zur  Feststellung  der  Localization  des  Nervenzellen.  Neur.  Cen- 
tralbl.  (1894),  S.  507-S(S.  Centralbl.  f.  Nervenh.  K.  und  Psychiatrie,  Bd. 
XVII  (1894,  S.  337-344.    Arch.  f.  Psychiat,  Bd.  XXVI  (1894),  S.  S97-6i2. 

(i)  "Ueber  die  sogenannte  Granula  der  Nervenzellen."  Neurolog- 
isches  Centralblatt.,  Bd.  XIII  (1894),  S.  676,  781,  810. 

(j)  "Mittheilungen  iiber  Karyokinese  in  Centralen  Nervensystem." 
Allg.  Ztsch.  f.  Psych.,  Bd.  LI   (1894),  S.  245. 

(k)  "Bernhard  von  Gudden's  hirnanatomische  experimentale  Unter- 
suchungen."     Allg.  Ztschr.  f.  Psychiat.,  Bd.  LI   (1894),  S.  527-549. 

(1)  "Der  gegenwartige  Stand  der  Nervenzellen  Anatomic  und  Path- 
ologic." Centr.  f.  Nervenheilk.  und  Psychiatrie,  Bd.  XVIII  (1895).  Allg. 
Ztsch.  f.  Psych.   (1895),  P-  981. 

(m)  "Ueber  die  Nomenclatur  in  der  nervenzellenanatomie  und  ihre 
nachsten  Ziele."     Neurolog.   Centralblatt.,  Bd.   XIV    (1895),   S.  96-104. 

(n)  "Mittheilungen  zur  pathologischen  Anatomic  der  Dementia  par- 
alytica."   Arch.  f.  Psychiatrie,  Bd.  XXVIII   (1896),  S.  987-992. 

(o)  "Ueber  die  Veranderungen  der  Nervenzellen  nach  experimentell 
erzeugter  Vergiftung,  Neurolog.  Centralblatt,  Bd.  XV.   (1896),  S.  9. 

(p)  "Die  Beziehungen  des  Nervenzellensubstanzen  zu  dem  thatigen 
ruhenden,  und  ermiideten  Zellzustanden."  Neurolog.  Centralblatt  (1896). 
Allg.  Ztschr.  f.  Psychiat.  (1896),  Bd.  LII  S.  1147. 

(q)  "Die  Hypothese  der  Specifischen  Nervenzellenf unction."  Allg. 
Ztschrft.  f.  Psych.  Berl.Bd.  LIV  (1897),  S.  1-107. 

(r)  "Ueber  die  ortlichen  Bau  verscheidenheiten  die  Himrinde."  Arch, 
f.  Psychiat.,  Bd.  XXIX   (1897),  S.  1025-1027. 

(s)  "Ueber  Nervenzellen  und  graue  Substanz."  Miinchen  med.  Woch., 
Bd.  XLV  (1898),  S.  988;  1023;  1060. 


Il8  G.  ALFRED  LAW  REN  Lh. 

(t)  Die  Neuronenlehre  und  ihre  Anhanger;  ein  Beitrag  zur  Losung 
des  Problems  der  Beziehungen  zwischen  Nervenzelle  Faser  und  gran.  Jena. 
1903- 

Obersteiner,  H.  "Central  Nervous  Organs,  Anatomy  of  in  Health 
and  Disease,"  p.  350  (1887). 

Popoff,  N.  M.  "Pathologische  anatomische  Veranderungen  des  Cen- 
tralnervensystems  bei  der  asiatischen  Cholera."     Virchow's  Archiv.,   1894, 

p.  57-        . 

Ranvier,  L.  "Legons  sur  I'histologie  du  systeme  nerveux."  Paris, 
1878. 

Remak,  R.  "Anatomische  Beobachtungen  iiber  das  Gehirn,  das 
Riickenmark,  und  die  Nervenwurzeln."  Muller's  Archiv.  f.  Anat.  und 
Phy.  (1841.) 

Neurologische  Erlautungen.  Arch.  f.  Anat.,  Physiol.,  u.  wissensch. 
Med.  Bui.,  1844,  S.  463-472. 

Rosin,  H.  "Ein  Beitrag  zur  Lehre  vom  Bau  der  Ganglienzellen." 
Deutsche  med.  Wochenschr.   Leipz.  u.   Berl.,   Bd.  XXII    (1896),   S.  495- 

497- 

Schaffer,  K.  "Kurze  Anmerkung  iiber  die  morphologische  Differenz 
des    Axencylinders    in    Verhaltnisse    zu     den     protoplasmatischen     Fort- 

satzen- bei  Nissl's  Farbung."  Neurol.  Central.,  Leipz.,  Bd.  XII    (1893),  S. 

489-857- 

Schultz,  Max,  in  Striker's,  S.  A.  "Manual  of  Histology."  Am.  trans- 
lation.   8vo.,  N.  Y.,  1872,  p.  134,  et  seq. 

Schwalbe,  G.  "Lehrbuch  der  Anatomic  des  Menschen,"  arranged  by 
Dr.  August  Rauber  (1885),  p.  463.    Fig.  279. 

Starr,  Learning  and  Strong.  "Atlas  of  Nerve  Cells,"  p.  72.  Fig.  10 
(1896). 

Vicq  d'Azyr,  Felix.  "Traite  d'anatomie  et  de  physiologie.'  V.  I.  "Anat- 
omic et  physiologie  du  cerveau,"  123,  117  pp.,  35  pi.  (1786.) 

Von  Lenhossek,  M.  "Der  feinere  Bau  des  Nervensystems  im  Lichte 
neuesten  Forschungen."     2te  Aufl.,  Berlin  (1895). 

"Ueber  Nervenzellenstructuren."  Vorhandl.  d.  Anat.  gesellsch.,  Jena 
(1896),  Bd.  X,  S.  15-21. 

EXPLANATION  OF  PLATES. 

Plate  I.  Fig.  i.  Brain  A.  Left  hemisphere.  Electrocuted  case,  nor- 
mal histologically. 

Plate  I.  Fig.  2.  Brain  A.  Suture  from  point  indicated  by  the  figure 
I  in  Plate  I.  Fig.  i.  Section  6  2-3  microns  in  thickness  stained  with 
methylene  blue  and  magnified  14  diameters. 

Plate  II.  Fig.  3.  Brain  A.  First  frontal  conv.  Strip  a  of  Plate  I, 
Fig.  2,  magnified  100  diameters. 

Plate  II.  Fig.  4.  Brain  A.  First  frontal  conv.  Cell  G.  of  Plate  II, 
Fig.  3  magnified  1400  diameters. 

Plate  II.  Fig.  5.  Brain  A.  First  frontal  conv.  Cell  H  of  Plate  II, 
Fig.  3  magnified  1,400  diameters. 

Plate  III.  Fig.  6.  Brain  A.  First  frontal  conv.  Group  of  spindle 
cells  /  of  third  layer  of  cortex  shown  at  /  in  Plate  II,  Fig.  3  magnified 
1,400  diameters. 

Plate  III.  Fig.  7.  Brain  A.  Ant.  cent,  conv.  Upper  third,  taken 
from  point  indicated  by  the  figure  2  in  Plate  I.,  Fig.  i.  Section  10  microns 
in  thickness  stained  with  methylene  violet,  and  magnified  14  diameters. 

Plate  III.  Fig.  8.  Brain  A.  Ant.  cent.  conv.  Upper  third.  Strip  a 
of  Plate  III,  Fig.  7  magnified  100  diameters. 

Plate  IV.     Fig.  9.     Brain  A.     Ant.  cent.  conv.     Uppe-  third.     Section 


DEMENTIA  PARALYTICA.  II9 

frt m  same  block  and  adjacent  to  that  shown  in  Plate  III,  Fig.  7.  Section 
10  microns  in  thickness,  stained  with  methylene  blue,  and  magnified  14 
diameters. 

Plate  IV.  Fig.  10.  Brain  A.  Ant.  cent.  conv.  Upper  third.  Strip 
a  of  Plate  IV,  Fig.  9,  magnified  ico  diameters. 

Plate  IV.  Fig.  11.  Brain  A.  Ant.  cent.  conv.  Upper  third.  Sec- 
tion taken  from  same  block  and  adjacent  to  that  shown  in  Plate  IV,  Fig.  9. 
Section  10  microns  in  thickness,  stained  with  methylene  blue,  and  magni- 
fied 14  diameters. 

Plate  IV.  Fig.  12.  Brain  A.  Ant.  cent.  conv.  Upper  third.  Giant  pyramidal 
cell  from  lower  portion  of  second  layer  of  cortex  from  section  adjacent  to 
that  shown  in  Plate  III,  Fig.  7.  Section  10  microns  in  thickness,  stained 
with  methylene  violet  and  magnified  1,400  diameters. 

Plate  V.  Fig.  13.  Brain  A.  Ant.  cent.  conv.  Upper  third.  Portion 
o  of  Plate  IV,  Fig.  11,  magnified  825  diameters. 

Plate  V.  Fig.  14.  Brain  A.  Ant.  cent.  conv.  Upper  third.  Two 
giant  pyramidal  cells  from  lower  portion  of  second  layer  of  cortex  from 
section  adjacent  to  that  shown  in  Plate  IV,  Fig.  9.  Section  10  microns  in 
thickness,  stained  with  methylene  blue  and  magnified  1,400  diameters. 

Plate  V.  Fig.  15.  Giant  pyramidal  cell  from  Ant.  cent.  conv.  Upper 
third,  lower  part  of  second  layer  from  approximately  the  same  region  as 
the  cells  shown  in  Plate  V,  Fig.  14,  and  stained  with  methylene  blue.  Sec- 
tion 10  microns  in  thickness,  and  magnified  1,400  diameters. 

Plate  VI.  Fig.  16.  Brain  A.  Ant.  cent.  conv.  Lower  third,  taken 
from  point  indicated  by  the  figure  4  in  Plate  I,  Fig.  i.  Section  10  microns 
in  thickness,   stained  with  methylene  violet,  and  magnified   10  diameters. 

Plate  VI.  Fig.  17.  Brain  A.  Ant.  cent.  conv.  Lower  third.  Strip  a 
of  Plate  VI,  Fig.  16,  magnified  100  diameters. 

Plate  VI.  Fig.  18.  Brain  A.  Post.  cent.  conv.  Middle  third.  Sec- 
tion taken  from  the  point  indicated  by  the  figure  5  in  Plate  I,  Fig.  i.  Sec- 
tion 6  2-3  microns  in  thickness,  stained  with  methylene  blue,  and  magni- 
fied 10  diameters. 

Plate  VII.  Fig.  19.  Brain  A.  Post.  cent.  conv.  Middle  third,  upper 
portion.  Strip  a  of  Plate  VI,  Fig.  18,  magnified  100  diameters  showing 
first  and  second  layers  and  upper  portion  only  of  third  layer. 

Plate  VII.  Fig.  20.  Brain  A.  Supra-marginal  conv.  of  parietal  re- 
gion taken  from  point  indicated  by  the  figure  7  in  Plate  I,  Fig.  i.  Sec- 
tion 6  2-'j  microns  in  thickness,  stained  with  methylene  violet,  and  magni- 
fied 14  diameters. 

Plate  VII.  Fig.  21.  Brain  A.  Supra-marginal  conv.  of  parietal  re- 
gion.   Strip  a  of  Plate  VII,  Fig.  20,  magnified  100  diameters. 

Plate  VIII.  Fig.  22.  Brain  A.  First  temp.  conv.  taken  from  point 
indicated  by  the  figure  6  in  Plate  I,  Fig.  i.  Section  6  2-3  microns  in  thick- 
ness, stained  with  methylene  blue,  and  magnified  14  diameters. 

Plate  VIII.  Fig.  23.  Brain  A.  First  temp.  conv.  Strip  a  of  Plate 
VIII,  Fig.  22,  magnified  100  diameters. 

Plate  VIII.  Fig.  24.  Brain  A.  Occipital  conv.  taken  from  point  indi- 
cated by  the  figure  8  in  Plate  I,  Fig.  i.  Section  6  2-3  microns  in  thickness, 
stained  with  methylene  violet  and  magnified  14  diameters. 

Plate  IX.  Fig.  25.  Brain  A.  Occipital  conv.  Strip  a  of  Plate  VIII, 
Fig.  24,  magnified  100  diameters. 

Plate  IX.  Fig.  26.  Brain  A.  Large  pyramidal  cells  from  layer  of 
large  pyramidal  cells  of  the  hippocampus  major  or  cornu  ammonis.  Sec- 
tion 6  2-3  microns  in  thickness,  stained  with  methylene  violet,  and  mag- 
nified   1,400   diameters. 

Plate  IX.    Fig.  27.    Brain  A.    Purkinje  and  granular  cells  from  cortex 


Date  Due 

i. 

1 

1 
1 

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f) 

RC381  U3 

Lavtfrence 


